SGLT2 inhibitors and lower limb complications: an updated meta-analysis

Abstract

Background: To exam the associations between the use of sodium glucose co-transporter 2 inhibitor (SGLT2i) and the risk of lower limb complications, and to analyze the associated factors.

Methods: Pubmed, Medline, Embase, the Cochrane Center Register of Controlled Trials for Studies and Clinicaltrial.gov were searched from the inception to November 2020. Randomized controlled trials of SGLT2i conducted in population containing diabetic patients with reports of amputation, peripheral arterial disease (PAD) and diabetic foot (DF) events were included. Random-effect model, fixed-effect model and meta-regression analysis were accordingly used.

Result: The numbers of SGLT2i users versus non-SGLT2i users in the analyses of amputation, PAD and DF were 40,925/33,414, 36,446/28,685 and 31,907/25,570 respectively. Compared with non-SGLT2i users, the risks of amputation and PAD were slightly increased in patients with canagliflozin treatment (amputation: OR = 1.60, 95% CI 1.04 to 2.46; PAD: OR = 1.53, 95 % CI 1.14 to 2.05). Meta-regression analyses indicated that greater weight reduction in SGLT2i users was significantly associated with the increased risks of amputation (β = - 0.461, 95% CI - 0.726 to - 0.197), PAD (β = - 0.359, 95% CI - 0.545 to - 0.172) and DF (β = - 0.476, 95% CI - 0.836 to - 0.116). Lower baseline diastolic blood pressure (β = - 0.528, 95% CI - 0.852 to - 0.205), more systolic blood pressure reduction (β = - 0.207, 95% CI - 0.390 to - 0.023) and more diastolic blood pressure reduction (β = - 0.312, 95% CI - 0.610 to - 0.015) were significantly associated with the increased risks of amputation, PAD and DF respectively in patients with SGLT2i treatment.

Conclusions: The risks of amputation and PAD were slightly increased in patients with canagliflozin treatment. Reductions in body weight and blood pressure were associated with lower limb complications in patients with SGLT2i treatment.

Keywords: Amputation; Blood pressure lowering agent; Diabetes mellitus; Diabetic foot; Peripheral arterial disease; Sodium glucose co‐transporter 2 inhibitor.

Fig. 1

The risk of amputation and PAD in patients with SGLT2i treatment. a The risk of amputation in patients with SGLT2i treatment. b The risk of PAD in patients with SGLT2i treatment. PAD, peripheral arterial disease; SGLT2i, sodium glucose co-transporter 2 inhibitor

Fig. 2

Meta-regression analysis for the associated factors and risk of lower limb complications in patients with SGLT2i treatment. a The association between weigh change and risk of amputation in patients with SGLT2i treatment. b The association between weigh change difference and risk of amputation in patients with SGLT2i treatment. c The association between baseline DBP and risk of amputation in patients with SGLT2i treatment. d The association between weigh change and risk of PAD in patients with SGLT2i treatment. e The association between weigh change difference and risk of PAD in patients with SGLT2i treatment. f The association between SBP change and risk of PAD in patients with SGLT2i treatment. g The association between weigh change and risk of DF in patients with SGLT2i treatment. h The association between weigh change difference and risk of DF in patients with SGLT2i treatment. i The association between DBP change and risk of DF in patients with SGLT2i treatment. DBP, diastolic blood pressure; DF, diabetic foot; PAD, peripheral arterial disease; SBP, systolic blood pressure; SGLT2i, sodium glucose co-transporter 2 inhibitor