Effect of SGLT2 inhibitors versus DPP4 inhibitors or GLP-1 agonists on diabetic foot-related extremity amputation in patients with T2DM: A meta-analysis.

Abstract

AIM:

To compare the contribution of sodium-glucose cotransporter-2 inhibitors (SGLT2is) with that of DPP4i or GLP-1ra toward lower extremity amputation rate.

METHODS:

Electronic databases were searched for articles published on the differences between the rates of lower extremity amputation among patients with type 2 diabetes mellitus (T2DM) undergoing SGLT2i treatment and those undergoing other anti-hyperglycemic agent (dipeptidyl peptidase-4 inhibitors [DPP4is], glucagon-like peptide-1 receptor agonist [GLP-1as], or sulfonylurea [SUs]) treatments. Random-effect models were used to generate data if heterogeneity was detected.

RESULTS:

Eight studies based on retrospective case-control designs with propensity matching were included. The propensity score-matching method increased credibility. Compared with SGLT2i treatment, DPP4i or GLP-1a treatment tended to result in a higher amputation rate (pooled hazard ratio [HR] = 1.1, 95% confidence interval [CI]: 0.98-1.23), whereas SU treatment resulted in similar amputation rates (pooled HR = 0.92, 95% CI: 0.74-1.13). After excluding the heterogeneous study, the meta-analysis of the remaining studies attained a statistical value (pooled HR = 0.81, 95% CI: 0.65-1.01).

CONCLUSION:

The study findings suggest that, with respect to diabetic foot-related limb amputations, SGLT2is are not superior to novel anti-hyperglycemic agents (DPP4is and GLP-1as) or other types of oral hypoglycemic agents (SUs). Therefore, SGLT2is may not have significantly positive effects on the prognosis for T2DM patients with complicated diabetic foot.

• Authors: Yaping Du, Lei Bai, Bingge Fan, Haixia Ding, Haiyan Ding, Lin Hou, Hongfang Ma, Na Xing, Fujun Wang
• Journal: Primary care diabetes (Prim Care Diabetes) Vol. 16 Issue 1 Pg. 156-161 (02 2022) ISSN: 1878-0210 [Electronic] England
• PMID: 34930687 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: Copyright © 2021 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Dipeptidyl-Peptidase IV Inhibitors
• Glucagon-Like Peptide-1 Receptor
• Hypoglycemic Agents
• Sodium-Glucose Transporter 2 Inhibitors
• Glucagon-Like Peptide 1
• DPP4 protein, human
• Dipeptidyl Peptidase 4

Topics

• Amputation, Surgical
• Diabetes Mellitus, Type 2 (complications, diagnosis, drug therapy)
• Diabetic Foot (diagnosis, drug therapy, surgery)
• Dipeptidyl Peptidase 4
• Dipeptidyl-Peptidase IV Inhibitors (adverse effects)
• Extremities
• Glucagon-Like Peptide 1
• Glucagon-Like Peptide-1 Receptor (agonists)
• Humans
• Hypoglycemic Agents (adverse effects)
• Retrospective Studies
• Sodium-Glucose Transporter 2 Inhibitors (adverse effects)