Meta-análise dos inibidores do transporte de glucose sódica 2 versus outros agentes hipoglicemiantes na progressão da retinopatia diabética e edema macular diabético

Resumo original em inglês

O que aconteceu

While glycemic control reduces the progression of diabetic retinopathy (DR), the effects of specific glucose-lowering drugs (GLD) remain incompletely defined. Emerging evidence suggests that sodium-glucose cotransporter‑2 inhibitors (SGLT2i) may confer protective effects on DR and diabetic macular edema (DME).

We reviewed human studies comparing SGLT2i versus other GLD with primary outcomes of DR or DME. Random effects meta-analyses and meta-regression were performed to estimate relative risks (rr) and risk differences (rd) for retinopathy progression.

O que encontraram

Of 273 identified studies, 16 met inclusion criteria, comprising 1,785,409 patients. Comparator subclasses included dipeptidyl peptidase-4 inhibitors (DPP-4i), Glucagon Like Peptide 1 -receptor agonists (GLP-1RA), sulfonylureas, and "other" GLD. SGLT2i therapy was associated with significantly lower rr of DR progression versus all GLD (rr = 0.77;95%CI:0.72,0.82,p < 0.001), and each of the subclasses. Similar reductions were observed for DME progression (rr = 0.75;95%CI:0.69,0.82,p < 0.001). Benefits were proportional to baseline rates; for cohorts with a 20%DR rate, the absolute rd was approximately 4%. The comparative benefit of SGLT2i was most pronounced versus sulfonylureas than to GLP-1RA and DPP-4i.

Por que isso importa

In patients with established DR or DME, SGLT2i may be preferred over DPP-4i and sulfonylureas, whereas choice of SGLT2i versus GLP-1RA should be guided by other comorbidities.

Resumo publicado sob licença CC BY. A tradução para o português ainda não chegou a este estudo.