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Meta-Analysis
. 2021 May 11;13(9):12748-12765.
doi: 10.18632/aging.202945. Epub 2021 May 11.

The different hypoglycemic effects between East Asian and non-Asian type 2 diabetes patients when treated with SGLT-2 inhibitors as an add-on treatment for metformin: a systematic review and meta-analysis of randomized controlled trials

Xianzhi Li  1   2 , Qianping Zhang  3 , Xiaojun Zhou  1   2 , Siyi Guo  4 , Shan Jiang  4 , Yuhan Zhang  2 , Ruzhen Zhang  2 , Jianjun Dong  4 , Lin Liao  1   2
Affiliations
Meta-Analysis

The different hypoglycemic effects between East Asian and non-Asian type 2 diabetes patients when treated with SGLT-2 inhibitors as an add-on treatment for metformin: a systematic review and meta-analysis of randomized controlled trials

Xianzhi Li et al. Aging (Albany NY). .

Abstract

Aims: To investigate the efficacy and safety of SGLT-2 inhibitors as an add-on treatment for metformin between Asian and non-Asian T2DM.

Methods: A systematic literature search of PubMed, EMBASE, and the Cochrane Library was performed through August 2020 with the following keywords: Sodium-Glucose Transporter 2 Inhibitors, Sodium Glucose Transporter 2 Inhibitors, SGLT2 inhibitor, SGLT-2 inhibitors, type 2 diabetes, and randomized controlled trials. Double-blinded RCTs comparing SGLT-2 inhibitors as an add-on treatment for metformin and metformin monotherapy in adults with type 2 diabetes were included. A random effects model was used to calculate overall effect sizes.

Results: 5 RCTs with 1193 Asian patients and 7 RCTs with 2098 non-Asian patients were investigated. The improvement in HbA1c and fasting blood glucose in the Asian patients (WMD, -0.73%; 95% CI, -1.01% to -0.46%, p < 0.01; WMD, -1.51; 95% CI, -1.81 to -1.21, p < 0.01, respectively) were both significantly better than in the non-Asians (WMD, -0.45%; 95% CI, -0.62% to -0.29%, p < 0.01; WMD, -1.03; 95% CI, -1.27 to -0.78, p < 0.01, respectively). The effect of weight loss was similar in the non-Asian patients and Asian patients. There was little difference in the improvement of systolic blood pressure between them. The risk of serious adverse events was not significantly increased between the Asian and non-Asian patients.

Conclusion: SGLT-2 inhibitors as an add-on treatment for metformin are more efficacious in East Asian T2DM patients than in non-Asian T2DM patients without an additional risk of severe adverse events.

Keywords: Asian; SGLT-2 inhibitors; meta-analysis; metformin; randomized controlled trial; type 2 diabetes.

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Conflict of interest statement

CONFLICTS OF INTEREST: All authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Evaluation of the risk of bias.
Figure 2
Figure 2
Flow diagram of study selection.
Figure 3A
Figure 3A
Forest plot of the weighted mean difference in the change of HbA1c from baseline.
Figure 3B
Figure 3B
Forest plot of the weighted mean difference in the change of HbA1c from baseline. (sensitivity analysis).
Figure 4
Figure 4
Forest plot of the weighted mean difference in the change of FPG from baseline.
Figure 5
Figure 5
Forest plot of the weighted mean difference in the change of body weight from baseline.
Figure 6
Figure 6
Forest plot of the weighted mean difference in the change of systolic blood pressure from baseline.
Figure 7
Figure 7
Forest plot of the odds ratio in the incidence of serious adverse events.
See this image and copyright information in PMC

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