{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,1,6]],"date-time":"2024-01-06T07:33:38Z","timestamp":1704526418810},"reference-count":0,"publisher":"Oxford University Press (OUP)","issue":"6","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,6,1]]},"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Patients with insulin-treated type 2 diabetes (T2D) have a high risk of major adverse cardiovascular events. Sodium-glucose cotransporter inhibitors (SGLTi) improve outcomes without hypoglycaemic risk.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Aims<\/jats:title>\n<jats:p>To study the effect of SGLTi in patients with T2D with and without background insulin treatment in outcome-driven RCTs.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Random effects models.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 54 374 patients with T2D were included in the analysis, of which 26 551 (48.8%) were treated with insulin. For 3P-MACE in patients without insulin treatment, the HR (95% CI) for the effect of SGLTi vs placebo was 0.93 (0.81\u20131.05), with moderate heterogeneity (I<jats:sup>2<\/jats:sup>\u2009=\u200949.2%, Q statistic <jats:italic>P<\/jats:italic>\u2009=\u20090.11). In insulin-treated patients, the HR (95% CI) was 0.88 (0.82\u20130.95), without evidence of heterogeneity (I<jats:sup>2<\/jats:sup> =0.0%, Q statistic <jats:italic>P<\/jats:italic> =0.91). The pooled effect evidenced a 10% reduction of 3P-MACE with SGLTi (HR: 0.90, 95% CI: 0.85\u20130.96), without SGLTi-by-insulin interaction <jats:italic>P<\/jats:italic>\u2009=\u20090.53. For the composite outcome of HF hospitalisation or cardiovascular death in patients without insulin treatment, the HR (95% CI) for the effect of SGLTi vs placebo was 0.77 (0.61-0.92), with marked heterogeneity (I<jats:sup>2<\/jats:sup>\u2009=\u200966.8%, Q statistic <jats:italic>P<\/jats:italic>\u2009=\u20090.02). In insulin-treated patients, the HR (95% CI) was 0.77 (0.68\u20130.86), without significant heterogeneity (I<jats:sup>2<\/jats:sup>\u2009=\u200931.7%, Q statistic <jats:italic>P<\/jats:italic>\u2009=\u20090.25). The pooled effect evidenced a 23% reduction of HF hospitalisations or cardiovascular death with SGLTi (HR: 0.77, 95% CI: 0.68\u20130.85), without SGLTi-by-insulin interaction <jats:italic>P<\/jats:italic> = 0.98.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>SGLTi reduces cardiovascular events regardless of insulin use. However, the treatment effect is more homogeneous among insulin-treated patients, supporting the use of SGLTi for the treatment of patients with T2D requiring insulin for glycaemic control.<\/jats:p>\n<\/jats:sec>","DOI":"10.1530\/eje-20-1484","type":"journal-article","created":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T18:16:50Z","timestamp":1616782610000},"page":"783-790","update-policy":"http:\/\/dx.doi.org\/10.1530\/crossmarkpolicy-7","source":"Crossref","is-referenced-by-count":3,"title":["Sodium-glucose co-transporter inhibitors in insulin-treated diabetes: a meta-analysis"],"prefix":"10.1093","volume":"184","author":[{"given":"Jo\u00e3o Pedro","family":"Ferreira","sequence":"first","affiliation":[{"name":"1Universit\u00e9 de Lorraine, Inserm, Centre d\u2019Investigations Cliniques, Plurith\u00e9matique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France"},{"name":"2Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal"}]},{"given":"Ana Cristina","family":"Oliveira","sequence":"additional","affiliation":[{"name":"2Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal"}]},{"given":"Francisca A","family":"Saraiva","sequence":"additional","affiliation":[{"name":"2Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal"}]},{"given":"Francisco","family":"Vasques-N\u00f3voa","sequence":"additional","affiliation":[{"name":"2Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal"}]},{"given":"Adelino","family":"Leite-Moreira","sequence":"additional","affiliation":[{"name":"2Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal"}]}],"member":"286","container-title":["European Journal of Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/eje.bioscientifica.com\/view\/journals\/eje\/184\/6\/EJE-20-1484.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/eje.bioscientifica.com\/downloadpdf\/journals\/eje\/184\/6\/EJE-20-1484.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T16:16:14Z","timestamp":1676391374000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejendo\/article\/184\/6\/783\/6653996"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,1]]},"references-count":0,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.1530\/eje-20-1484","relation":{},"ISSN":["0804-4643","1479-683X"],"issn-type":[{"value":"0804-4643","type":"print"},{"value":"1479-683X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,1]]}}}