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SGLT2 Inhibitors in COVID-19: Umbrella Review, Meta-Analysis, and Bayesian Sensitivity Assessment

Vinay Suresh1, Muhammad Aaqib Shamim2, Victor Ghosh3

  • 1King George's Medical University, Lucknow 226003, India.

Diseases (Basel, Switzerland)
|March 26, 2025
PubMed
Abstract

Insights

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) significantly reduce mortality and hospitalization in COVID-19 patients with type 2 diabetes. Further research is needed for post-hospitalization use and critical conditions.

Area of Science:

  • Infectious Diseases
  • Endocrinology
  • Cardiology

Background:

  • Growing evidence suggests antidiabetic medications may reduce COVID-19 mortality.
  • This study focuses on SGLT2 inhibitors (SGLT2is) for COVID-19 patients with type 2 diabetes mellitus (T2DM).

Purpose of the Study:

  • To conduct an umbrella review and meta-analysis of SGLT2 inhibitors in COVID-19 patients with T2DM.
  • To assess the efficacy and safety of SGLT2is in this patient population.

Main Methods:

  • Systematic search of MEDLINE, EMBASE, Cochrane, and ClinicalTrials.gov databases.
  • Umbrella review of systematic reviews and meta-analyses, critically appraised using AMSTAR 2.0.
  • Meta-analysis of relevant trials and observational studies, adhering to PRISMA guidelines.

Main Results:

  • SGLT2is significantly lowered odds of mortality (OR 0.67) and hospitalization (OR 0.84) in COVID-19 patients with T2DM.
  • Bayesian analyses supported most findings; however, some differences were noted.
  • An increased odds of diabetic ketoacidosis (OR 1.20) was observed. Evidence quality was low to very low.

Conclusions:

  • Prophylactic SGLT2i use reduces mortality and hospitalization in COVID-19 patients with diabetes.
  • The efficacy of SGLT2is post-hospitalization and under critical conditions remains uncertain.
  • Individualized patient assessment is crucial for integrating SGLT2is into COVID-19 management.
Keywords:
Bayesian sensitivityCOVID-19SGLT2 inhibitorsSGLT2ihospitalisationmeta-analysismortalitytype 2 diabetes mellitus

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