Success of diabetes treatments varies by cardiovascular risk

Patients with diabetes and increased CVD risk who also received one of several diabetes treatments were more likely to have certain “favorable” health outcomes, researchers reported.

The authors of a systematic review and network analysis concluded that among patients with diabetes and low CVD risk, the effect of diabetes treatment on patients’ vascular outcomes mirrored that of placebo.

Apostolos Tsapas, MD, MScPhD, head of the Diabetes Center at Ippokratio General Hospital in Thessaloniki, Greece, and colleagues reviewed 453 English-language randomized trials at least 24 weeks long with 320,474 participants. Researchers added that the trials contained 23 antidiabetic medications from nine drug classes and evaluated the effects of the glucose-lowering drugs on mortality, glycemic, and vascular outcomes.

Tsapas and colleagues found that among patients with diabetes at higher CVD risk, no treatment was different than placebo for vascular outcomes. In patients at increased cardiovascular risk receiving metformin-based background therapy, specific GLP-1 RAs and SGLT-2 inhibitors had a “favorable effect” on certain cardiovascular outcomes. The researchers also said their confidence in the data varied by agent and outcome.

In a related editorial, Christine G. Lee, MD, MS, and William T. Cefalu, MD, of the National Institute of Diabetes and Digestive and Kidney Diseases, called the systematic review and network meta-analysis “rigorous” and “transparent.”

However, they added that there was also “low confidence” in the medication trial data, “insufficient comparative evidence” regarding a cohort with low CVD risk and “limited” data on diabetes-related outcomes.

“Clinical trials should attempt to enroll a more heterogeneous patient population that includes the full range of cardiovascular risk and diabetes duration and should try to categorize these factors similarly,” Lee and Cefalu wrote.

Future studies should also examine a core set of secondary, patient-important outcomes, they added.

References

• Lee CG, et al. Ann Intern Med. 2020;doi:10.7326/M20-4266.
• Tsapas A, et al. Ann Intern Med. 2020;doi:10.7326/M20-0864.