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Effect of SGLT-2 inhibitors on cardiac autonomic function in type 2 diabetes mellitus: a meta-analysis of randomized

Dimitrios Patoulias1, Alexandra Katsimardou2, Nikolaos Fragakis3

  • 1Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Konstantinoupoleos 49, 54642, Thessaloníki, Greece. dipatoulias@gmail.com.

Acta Diabetologica
|August 19, 2022
PubMed
Abstract

Insights

Sodium-glucose co-transporter-2 (SGLT-2) inhibitors did not significantly improve cardiac autonomic neuropathy (CAN) indices in patients with type 2 diabetes mellitus (T2DM). Further research is needed to explore potential benefits of SGLT-2 inhibitors on CAN.

Area of Science:

  • Cardiology
  • Endocrinology
  • Diabetology

Background:

  • Cardiac autonomic neuropathy (CAN) is a frequent complication in type 2 diabetes mellitus (T2DM).
  • Understanding the impact of novel therapeutic agents on CAN is crucial for diabetes management.

Purpose of the Study:

  • To evaluate the efficacy of sodium-glucose co-transporter-2 (SGLT-2) inhibitors in improving cardiac autonomic neuropathy (CAN) indices.
  • To synthesize evidence from randomized controlled trials (RCTs) assessing SGLT-2 inhibitors' effects on CAN.

Main Methods:

  • Systematic search of PubMed, Cochrane Library, and gray literature for parallel or cross-over RCTs.
  • Inclusion of adult patients with T2DM treated with SGLT-2 inhibitors versus placebo or active comparator.
  • Primary outcome: change in low-frequency-to-high-frequency (LF/HF) ratio; Secondary outcomes: changes in SDNN and r-MSSD.

Main Results:

  • Pooled data from four RCTs involving 247 T2DM patients.
  • No significant effect of SGLT-2 inhibitors on LF/HF ratio (MD = -0.11, 95% CI -0.35 to 0.12).
  • No significant impact on SDNN (MD = -2.83, 95% CI -7.41 to 1.75) or r-MSSD (MD = -0.14, 95% CI -3.52 to 3.25).
  • Low risk of bias across included studies.

Conclusions:

  • SGLT-2 inhibitor treatment does not appear to offer significant benefits for cardiac autonomic neuropathy (CAN) indices in T2DM patients.
  • Current evidence suggests no improvement in heart rate variability parameters associated with CAN.
Keywords:
Cardiac autonym neuropathyCardiovascular diseasePrognosisSGLT-2 inhibitorType 2 diabetes mellitus

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