GLP-1 receptor agonists and SGLT2 inhibitors for older people with type 2 diabetes: A systematic review and meta-analysis

Thomas Karagiannis; Apostolos Tsapas; Eleni Athanasiadou; Ioannis Avgerinos; Aris Liakos; David R Matthews; Eleni Bekiari

doi:10.1016/j.diabres.2021.108737

GLP-1 receptor agonists and SGLT2 inhibitors for older people with type 2 diabetes: A systematic review and meta-analysis

Diabetes Res Clin Pract. 2021 Apr:174:108737. doi: 10.1016/j.diabres.2021.108737. Epub 2021 Mar 8.

Authors

Thomas Karagiannis¹, Apostolos Tsapas², Eleni Athanasiadou³, Ioannis Avgerinos³, Aris Liakos³, David R Matthews⁴, Eleni Bekiari⁵

Affiliations

¹ Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece. Electronic address: tkaragian@auth.gr.
² Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; Harris Manchester College, University of Oxford, Oxford, United Kingdom.
³ Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁴ Harris Manchester College, University of Oxford, Oxford, United Kingdom; Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, United Kingdom.
⁵ Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.

PMID: 33705820
DOI: 10.1016/j.diabres.2021.108737

Abstract

Aims: To assess the cardiovascular effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter-2 (SGLT2) inhibitors in older people with type 2 diabetes.

Methods: PubMed, Embase, and Cochrane library were searched up to November 2020 for cardiovascular outcomes trials with GLP-1 RAs or SGLT2 inhibitors that reported results for older patients with type 2 diabetes. Random-effects meta-analyses were conducted for different age subgroup categories.

Results: A total of 11 studies (93,502 patients) were included. Consistent with their effect in the overall population, in patients ≥65 years, GLP-1 RAs reduced major adverse cardiovascular events (MACE) (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.80-0.92), cardiovascular death, stroke, and myocardial infarction. In the same age subgroup, SGLT2 inhibitors reduced MACE (HR, 0.90; 95% CI, 0.83-0.98) but had a neutral effect on its components. They also reduced heart failure hospitalization (HR, 0.62; 95% CI, 0.51-0.76), an effect that was not evident in patients <65 years, and the composite renal endpoint (HR, 0.57; 95% CI, 0.43-0.77). Meta-analyses for patients ≥75 years yielded similar results.

Conclusions: In older adults with diabetes, GLP-1 RAs reduced MACE and its components. SGLT2 inhibitors reduced MACE, and heart failure and renal outcomes.

Keywords: Cardiovascular outcomes; Heart failure; Meta-analysis; Older adults; Renal outcomes; Type 2 diabetes.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Aged
Aged, 80 and over
Diabetes Mellitus, Type 2 / drug therapy*
Female
Glucagon-Like Peptide-1 Receptor / agonists*
Humans
Male
Risk Factors
Sodium-Glucose Transporter 2 Inhibitors / pharmacology
Sodium-Glucose Transporter 2 Inhibitors / therapeutic use*

Substances

Glucagon-Like Peptide-1 Receptor
Sodium-Glucose Transporter 2 Inhibitors