Abstract:

Objective Type 2 diabetes is a chronic disease and heart failure is a common complication of type 2 diabetes, and large studies have demonstrated the role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in improving cardiovascular outcomes of patients with type 2 diabetes. In this paper, the efficacy effects of five different SGLT2i were indirectly compared by systematic evaluation. Methods PubMed, Web of science, Cochrane Library, CNKI, WanFang, and VIP databases were searched to collect relevant literature with a search time frame of build to July 2022. Two researchers independently screened the literature and extracted the corresponding data, using the composite outcome of heart failure hospitalization and cardiovascular death as the primary outcome indicator, with heart failure hospitalization, cardiovascular death and all-cause death as secondary outcome indicators, and a network meta-analysis was performed using Stata 16.0 as well as the network program package. Results A total of 340 publications were retrieved, eligible 11 publications representing 62 904 patients were included. The five intervention methods were involved, namely: empagliflozin, sotagliflozin, dapagliflozin, ertugliflozin and canagliflozin. There were no statistically significant differences (P>0.05) between the five different SGLT2i in altering the composite outcomes of heart failure hospitalization and cardiovascular death, cardiovascular death, heart failure hospitalization and all-cause death in patients with type 2 diabetes. All five different SGLT2i significantly improved heart failure hospitalization outcomes in patients with type 2 diabetes compared to placebo. There was a statistically significant difference between empagliflozin and sotagliflozin in improving the composite outcome of heart failure hospitalization and cardiovascular death. No significant difference between placebo and the five different SGLT2i in improving the outcome of cardiovascular death or all-cause death. Conclusion There was a trend towards a more significant benefit of empagliflozin and sotagliflozin improving the composite outcome of heart failure hospitalization and cardiovascular death and heart failure hospitalization outcome in type 2 diabetic patients, while for cardiovascular death or all-cause death outcome, there was no statistically significant difference between the five different SGLT2i and placebo, and the exact mechanisms and causes still need to be explored and validated in large studies.

Key words: diabetes mellitus, type 2, heart failure, adverse cardiovascular events, meta-analysis, sodium-glucose cotransporter inhibitors