Comparative Renal Effects of Dipeptidyl Peptidase-4 Inhibitors and Sodium-Glucose Cotransporter 2 Inhibitors on Individual Outcomes in Patients with Type 2 Diabetes: A Systematic Review and Network Meta-Analysis
- Authors
- Bae, Jae Hyun; Park, Eun-Gee; Kim, Sunhee; Kim, Sin Gon; Hahn, Seokyung; Kim, Nam Hoon
- Issue Date
- Apr-2021
- Publisher
- KOREAN ENDOCRINE SOC
- Keywords
- Albuminuria; Diabetes mellitus, type 2; Diabetic nephropathies; Dipeptidyl-peptidase IV inhibitors; Kidney failure, chronic; Network meta-analysis; Sodium-glucose transporter 2 inhibitors; Systematic review
- Citation
- ENDOCRINOLOGY AND METABOLISM, v.36, no.2, pp.388 - 400
- Indexed
- SCIE
SCOPUS
KCI
- Journal Title
- ENDOCRINOLOGY AND METABOLISM
- Volume
- 36
- Number
- 2
- Start Page
- 388
- End Page
- 400
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/128372
- DOI
- 10.3803/EnM.2020.912
- ISSN
- 2093-596X
- Abstract
- Background: To compare the renal effects of dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose cotransporter 2 (SGLT2) inhibitors on individual outcomes in patients with type 2 diabetes. Methods: We searched electronic databases (MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials) from inception to June 2019 to identity eligible randomized controlled trials of DPP-4 inhibitors or SGLT2 inhibitors that reported at least one kidney outcome in patients with type 2 diabetes. Outcomes of interest were microalbuminuria, macroalbuminuria, worsening nephropathy, and end-stage kidney disease (ESKD). We performed an arm-based network meta-analysis using Bayesian methods and calculated absolute risks and rank probabilities of each treatment for the outcomes. Results: Seventeen studies with 87,263 patients were included. SGLT2 inhibitors significantly lowered the risks of individual kidney outcomes, including microalbuminuria (odds ratio [OR], 0.64; 95% credible interval [CrI], 0.41 to 0.93), macroalbuminuria (OR, 0.48; 95% CrI, 0.24 to 0.72), worsening nephropathy (OR, 0.65; 95% CrI, 0.44 to 0.91), and ESKD (OR, 0.65; 95% CrI, 0.46 to 0.98) as compared with placebo. However, DPP-4 inhibitors did not lower the risks. SGLT2 inhibitors were considerably associated with higher absolute risk reductions in all kidney outcomes than DPP-4 inhibitors, although the benefits were statistically insignificant. The rank probabilities showed that SGLT2 inhibitors were better treatments for lowering the risk of albuminuria and ESKD than placebo or DPP-4 inhibitors. Conclusion: SGLT2 inhibitors were superior to DPP-4 inhibitors in reducing the risk of albuminuria and ESKD in patients with type 2 diabetes.
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