PMID- 37905204
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231101
IS  - 1663-9812 (Print)
IS  - 1663-9812 (Electronic)
IS  - 1663-9812 (Linking)
VI  - 14
DP  - 2023
TI  - Safety of sodium-glucose transporter 2 (SGLT-2) inhibitors in patients with type 
      2 diabetes: a meta-analysis of cohort studies.
PG  - 1275060
LID - 10.3389/fphar.2023.1275060 [doi]
LID - 1275060
AB  - Aims: This study aimed to investigate the association between the use of 
      sodium-glucose transporter 2 inhibitors (SGLT-2i) and the risk of diabetic 
      ketoacidosis (DKA), lower limb amputation (LLA), urinary tract infections (UTI), 
      genital tract infections (GTI), bone fracture, and hypoglycemia in cohort 
      studies. Methods: A systematic search was conducted in the PubMed and Embase 
      databases to identify cohort studies comparing the safety of SGLT-2i versus other 
      glucose-lowering drugs (oGLD) in patients with type 2 diabetes mellitus (T2DM). 
      The quality of the studies was assessed using the Newcastle-Ottawa Scale. Primary 
      endpoints were DKA and LLA, while secondary endpoints included UTI, GTI, bone 
      fracture, and hypoglycemia. Hazard ratios (HR) with 95% confidence intervals (CI) 
      were calculated. Results: A total of 9,911,454 patients from 40 cohort studies 
      were included in the analysis. SGLT-2i use was associated with a higher risk of 
      DKA (HR: 1.21, 95% CI: 1.07-1.38, p = 0.003) and GTI (HR: 2.72, 95% CI: 
      2.48-2.98, p < 0.01). However, it was not associated with an increased risk of 
      LLA (HR: 1.06, 95% CI: 0.92-1.23, p = 0.42), UTI (HR: 0.99, 95% CI: 0.89-1.10, p 
      = 0.83), or bone fracture (HR: 0.99, 95% CI: 0.94-1.04, p = 0.66). Furthermore, 
      SGLT-2i was associated with a reduced risk of hypoglycemia. Furthermore, compared 
      to dipeptidyl peptidase 4 inhibitors, SGLT-2i as a class and individually was 
      associated with an increased risk of DKA. Canagliflozin specifically increased 
      the risk of LLA (HR: 1.19, 95% CI: 1.04-1.36, p = 0.01). The subgroup analysis 
      suggested that SGLT-2i increased the risk of LLA among patients with a history of 
      cardiovascular disease. Conclusion: SGLT-2i versus oGLD was associated with a 
      similar occurrence of LLA, UTI, and bone fracture. However, SGLT-2i was 
      associated with a higher risk of DKA and GTI than oGLD. These findings provide 
      valuable information on the safety profile of SGLT-2i in patients with T2DM and 
      can help inform clinical decision-making.
CI  - Copyright (c) 2023 Li, Liu, Zhang, Xie, Geng, Man, Li, Mao, Qiao and Liu.
FAU - Li, Chun Xing
AU  - Li CX
AD  - Department of Pharmacy, Aerospace Center Hospital, Beijing, China.
FAU - Liu, Tian Tian
AU  - Liu TT
AD  - Department of Pharmacy, Aerospace Center Hospital, Beijing, China.
FAU - Zhang, Qian
AU  - Zhang Q
AD  - College of Pharmacy, Hebei Medical University, Shijiazhuang, China.
FAU - Xie, Qing
AU  - Xie Q
AD  - Department of Pharmacy, Aerospace Center Hospital, Beijing, China.
FAU - Geng, Xu Hua
AU  - Geng XH
AD  - Aerospace School of Clinical Medicine, Peking University, Beijing, China.
FAU - Man, Chun Xia
AU  - Man CX
AD  - Department of Pharmacy, Aerospace Center Hospital, Beijing, China.
FAU - Li, Jia Yi
AU  - Li JY
AD  - Department of Pharmacy, Aerospace Center Hospital, Beijing, China.
FAU - Mao, Xin Ying
AU  - Mao XY
AD  - Department of Pharmacy, Aerospace Center Hospital, Beijing, China.
FAU - Qiao, Yue
AU  - Qiao Y
AD  - Department of Pharmacy, Aerospace Center Hospital, Beijing, China.
FAU - Liu, Hua
AU  - Liu H
AD  - Department of Pharmacy, Aerospace Center Hospital, Beijing, China.
LA  - eng
PT  - Systematic Review
DEP - 20231013
PL  - Switzerland
TA  - Front Pharmacol
JT  - Frontiers in pharmacology
JID - 101548923
PMC - PMC10613530
OTO - NOTNLM
OT  - diabetic ketoacidosis
OT  - genital tract infections
OT  - lower limb amputation
OT  - meta-analysis
OT  - safety
OT  - sodium-glucose transporter 2 inhibitors
OT  - urinary tract infections
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2023/10/31 06:42
MHDA- 2023/10/31 06:43
PMCR- 2023/10/13
CRDT- 2023/10/31 04:05
PHST- 2023/08/09 00:00 [received]
PHST- 2023/09/21 00:00 [accepted]
PHST- 2023/10/31 06:43 [medline]
PHST- 2023/10/31 06:42 [pubmed]
PHST- 2023/10/31 04:05 [entrez]
PHST- 2023/10/13 00:00 [pmc-release]
AID - 1275060 [pii]
AID - 10.3389/fphar.2023.1275060 [doi]
PST - epublish
SO  - Front Pharmacol. 2023 Oct 13;14:1275060. doi: 10.3389/fphar.2023.1275060. 
      eCollection 2023.