Glucose-lowering Drugs and Hospitalization for Heart Failure: A Systematic Review and Additive-effects Network Meta-analysis With More Than 500 000 Patient-years

Abstract Background Sodium glucose co-transporter 2 inhibitors (SGLT2is) prevent hospitalization resulting from heart failure (HHF). However, patients with type diabetes mellitus use multiple antihyperglycemic drugs to achieve glycosylated hemoglobin (HbA1c) targets. In these drug combinations, the risk of HHF is unpredictable and so parallel effect glucose-lowering. Purpose To examine impact their association on HHF. Data Sources Forty randomized controlled trials (RCTs) reporting Study Selection Published RCTs were data source. Extraction Incidence rates Synthesis Random additive-effects network meta-analysis showed that metformin (P = 0.55), sulfonylureas 0.51), glucagon-like peptide-1 receptor-agonist 0.16), dipeptidyl peptidase 4 (DPP4is; P 0.54) neutral SGLT2is + DPP4is reduced a hazard ratio (HR) 0.68 (95% CI, 0.60-0.76; < 0.0001) 0.70 0.60-0.81; 0.0001), respectively. Increased was associated thiazolidinediones (TZDs) as monotherapy or in combination (HR: 1.45; 95% 1.18-1.78; 0.0004) 1.49 1.18-1.88; 0.0008), Regardless therapy, 1% reduction HbA1c by 31.3% 9-48; 0.009). Limitations There are no verify combinations available for clinical discriminate within each therapeutic classes. Conclusions The increased TZDs combination. Glucose-lowering provides an additive reducing