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Metabolic effects of antihyperglycemic agents and mortality: meta-analysis of randomized controlled trials

Dimitris Varvaki Rados1, Camila Viecceli2, Lana Catani Pinto2

  • 1Post-Graduate Program in Medical Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2300, 2º floor, Porto Alegre, RS, 90035-903, Brazil. dvarvaki@gmail.com.

Scientific Reports
|August 1, 2020
PubMed

Insights

Antihyperglycemic medications improving metabolic factors like HbA1c and blood pressure are linked to reduced mortality in type 2 diabetes. This suggests a better metabolic profile may lower cardiovascular risks.

Area of Science:

  • Endocrinology
  • Cardiology
  • Pharmacology

Background:

  • Antihyperglycemic medications for type 2 diabetes exhibit varied effects on cardiovascular outcomes.
  • The impact of these drugs on intermediate metabolic factors may explain observed mortality differences.

Purpose of the Study:

  • To systematically review the relationship between metabolic factors, drug mechanisms, and mortality effects of antihyperglycemic medications.
  • To explore how HbA1c, severe hypoglycemia, body weight, and blood pressure influence cardiovascular mortality in type 2 diabetes.

Main Methods:

  • Systematic review of randomized trials on antihyperglycemic medications and mortality in type 2 diabetes.
  • Meta-analyses and meta-regressions evaluated effects on HbA1c, severe hypoglycemia (SH), body weight, systolic blood pressure (SBP), and mechanism of action.
  • Secondary outcomes included myocardial infarction, stroke, and heart failure.

Main Results:

  • Medications reducing HbA1c, SH, body weight, and SBP were associated with lower all-cause mortality.
  • Lower HbA1c, SH, and SBP correlated with decreased cardiovascular mortality, myocardial infarction, and stroke.
  • Favorable metabolic profiles, particularly lower SH, body weight, and SBP, were linked to reduced heart failure risk.

Conclusions:

  • Antihyperglycemic medications with improved metabolic profiles show association with reduced all-cause and cardiovascular mortality.
  • These findings, derived from indirect comparisons, necessitate cautious clinical application.

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