Abstract
To investigate the effect of sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) agonists on glycemic variability (GV), the mean amplitude of glucose excursion (MAGE), mean blood glucose (MBG) levels, and percentage of time maintaining euglycemia were evaluated. Randomized controlled trials evaluating the efficacy of SGLT-2 inhibitors and GLP-1 agonists for treating people with diabetes were selected through searches of PubMed, EMBASE, and other databases. Sixteen studies were finally analyzed. There were no differences in the reductions in MAGE after treatment with SGLT-2 inhibitors or GLP-1 agonists (standardized mean difference (SMD) = −0.59, 95% CI = −0.82 to −0.36 vs. SMD = −0.43, 95% CI = −0.51 to −0.35, respectively), and treatment with SGLT-2 inhibitors was associated with an increased reduction in MBG levels (SMD = −0.56, 95% CI = −0.65 to −0.48, p < 0.00001). Monotherapy and add-on therapy with medications were correlated with MAGE and MBG level reductions. In conclusion, SGLT-2 inhibitors and GLP-1 agonists were associated with a reduction in GV and could be alternatives for treating people with diabetes.
Highlights
Glycemic control is an important concern in diabetes care and associated with a reduced risk of macrovascular and microvascular complications [1]
As the use of a continuous glucose monitoring system (CGMS) is recommended to assess diabetes treatment, indexes representing glycemic variability (GV), such as the mean amplitude of glucose excursion (MAGE), mean blood glucose (MBG) levels, and percentage of time maintaining euglycemia should be extensively evaluated [3,5] to verify the tradeoffs in glycemic targets [6]
Several head-to-head or network meta-analyses [1,7,8,9] indicated that sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) agonists effectively improve glycemic control and relative complications in clinical outcomes associated with HbA1c, such as cardiovascular and renal outcomes
Summary
Glycemic control is an important concern in diabetes care and associated with a reduced risk of macrovascular and microvascular complications [1]. As the use of a continuous glucose monitoring system (CGMS) is recommended to assess diabetes treatment, indexes representing GV, such as the mean amplitude of glucose excursion (MAGE), mean blood glucose (MBG) levels, and percentage of time maintaining euglycemia should be extensively evaluated [3,5] to verify the tradeoffs in glycemic targets [6]. Several head-to-head or network meta-analyses [1,7,8,9] indicated that SGLT-2 inhibitors and GLP-1 agonists effectively improve glycemic control and relative complications in clinical outcomes associated with HbA1c, such as cardiovascular and renal outcomes. To the best of our knowledge, no head-to-head meta-analyses have evaluated GV, including net changes in MAGE, MBG levels, and percentage of time maintaining euglycemia, during diabetes treatment with SGLT-2 inhibitors or GLP-1 agonists. This systematic review and meta-analysis aimed to investigate the effects of SGLT-2 inhibitors and GLP-1 agonists on GV measured using MAGE, MBG levels, and percentage of time maintaining euglycemia
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