Introduction
In the realm of type 2 diabetes treatment, various therapeutic agents play crucial roles in managing the condition. Like actors in the action-packed sequel “Transporter 2,” each treatment brings unique strengths and considerations to the forefront. This article delves into a comparative analysis of two prominent classes of medications: sodium-glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs). We explore their efficacy and tolerability in adult patients with type 2 diabetes, drawing upon evidence from rigorous clinical trials.
Methods and Materials
To comprehensively assess the roles of these “Transporter 2 Actors” in diabetes care, we conducted a systematic review of electronic databases. Our search spanned from the inception of these databases up to April 24, 2019. We focused on randomized controlled trials (RCTs) that reported changes in glycated haemoglobin (HbA1c) levels, a key indicator of blood sugar control, at approximately 24 and/or 52 weeks. These trials investigated the effects of SGLT-2is and/or GLP-1RAs, categorizing GLP-1RAs into short-acting and long-acting formulations. To synthesize the available evidence and facilitate direct comparisons within and between these drug classes, we employed Bayesian network meta-analyses. This robust statistical approach allowed us to evaluate cardiometabolic efficacy and adverse event profiles (PROSPERO registration number: CRD42018091306).
Results
Our extensive search identified a substantial body of research, encompassing 64 trials. This included 53 trials with a 24-week duration, seven trials extending to 52 weeks, and four trials providing data at both 24 and 52 weeks. The combined data from these trials involved a total of 31,384 participants, providing a robust foundation for our analysis.
Alt: Medical professionals in a meeting room, reviewing charts and discussing different diabetes treatment options, representing the actors in diabetes management.
The findings consistently demonstrated that all investigated treatments, when compared to placebo, led to significant improvements in HbA1c levels. However, notable differences emerged when comparing the active treatments directly. Long-acting GLP-1RAs exhibited superior HbA1c reduction compared to both short-acting GLP-1RAs and SGLT-2is. Semaglutide, a specific long-acting GLP-1RA, stood out by demonstrating a greater HbA1c reduction compared to placebo and all other treatments at both 24 weeks [-1.49% (95% credible interval: -1.76, -1.22)] and 52 weeks [-1.38% (-2.05, -0.71)].
Alt: Bar chart comparing the reduction in HbA1c levels achieved by different diabetes medications, including long-acting GLP-1RAs and SGLT-2is, highlighting semaglutide’s superior performance.
Beyond glycemic control, we observed differential effects on other cardiometabolic parameters. Long-acting GLP-1RAs demonstrated benefits in reducing body weight and waist circumference, addressing key concerns for many individuals with type 2 diabetes. In contrast, SGLT-2is showed a distinct advantage in reducing blood pressure levels, an important factor in cardiovascular risk management.
Alt: Graphic illustrating the effects of different diabetes drugs on body weight and blood pressure, visually comparing the weight loss benefits of GLP-1RAs and blood pressure reduction of SGLT-2is.
Regarding adverse events, SGLT-2is were associated with an increased risk of genital infections compared to long-acting GLP-1RAs [odds ratio (95% credible interval): 5.26 (1.45, 25.00)]. Conversely, GLP-1RAs, both short-acting and long-acting, showed an increased risk of diarrhoea compared to SGLT-2is [short-acting GLP-1RAs: 1.65 (1.09, 2.49); long-acting GLP-1RAs: 2.23 (1.51, 3.28)]. No other significant differences in adverse events were detected between SGLT-2is and GLP-1RAs in our analysis.
Conclusion
Our comprehensive network meta-analysis provides valuable insights into the comparative efficacy and tolerability of SGLT-2is and GLP-1RAs in adults with type 2 diabetes. Long-acting GLP-1RAs emerged as superior in reducing HbA1c levels, body weight, and waist circumference. SGLT-2is, on the other hand, demonstrated notable reductions in blood pressure. This evidence base is crucial for clinicians in formulating informed treatment recommendations and tailoring management strategies to the specific needs of individuals with type 2 diabetes. Just as the right actors are essential for a successful sequel, selecting the appropriate therapeutic agents is paramount for effective diabetes management and improving patient outcomes.
References
