Article type
Abstract
Background: Type 2 diabetes mellitus (T2DM) is increasingly being diagnosed in older adults. However, whether older patients should follow the same prescription algorithm as younger patients remained uncertain due to limited evidence. Our study objective was to address this issue.
Methods: A systematic review and network meta-analysis were conducted to identify randomized controlled trials that examined cardiovascular or renal outcomes in patients aged ≥65 years with T2DM. We searched PubMed, Cochrane CENTRAL, and Embase up to September 23, 2023. No limitations were imposed on the language or timeframe of publication. Studies were assessed using the Cochrane ROB 2.0 tool. Data were extracted and verified by 2 reviewers. The predefined research protocol was officially published in PROSPERO under the registration number CRD42023437068.
Results: There was a total of 21 trials that involved 41,594 participants. The analysis incorporated the sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), dipeptidyl peptidase-4 (DPP-4) inhibitors, metformin, sulfonylureas, and acarbose. The network meta-analysis revealed that GLP-1RAs were the sole agents that exhibited a significant reduction in the risk of major adverse cardiovascular events (risk ratio [RR], 0.83; 95% confidence interval [CI], 0.71 to 0.97). Significant preventive effect of SGLT2 inhibitors was observed in terms of hospitalization for heart failure (RR, 0.66; 95% CI, 0.57 to 0.77) and renal composite outcome (RR, 0.69; 95% CI, 0.53 to 0.89). Relative ranking evaluated by P-scores also demonstrated similar trends. Notably, the number of treatments needed decreased in most analytical findings among subpopulations as age increased.
Conclusions: Novel anti-diabetic agents should be prioritized as the preferred treatment options for elderly diabetic patients, particularly those with an elevated risk of cardiovascular disease or heart failure.
The relevance and importance to patients: Our study provides a comprehensive analysis of the body of evidence regarding the various benefits and drawbacks of all available antidiabetic medications. This information would empower medical decision-makers to adopt a personalized, precise, and tailored approach in their treatment strategies.
Methods: A systematic review and network meta-analysis were conducted to identify randomized controlled trials that examined cardiovascular or renal outcomes in patients aged ≥65 years with T2DM. We searched PubMed, Cochrane CENTRAL, and Embase up to September 23, 2023. No limitations were imposed on the language or timeframe of publication. Studies were assessed using the Cochrane ROB 2.0 tool. Data were extracted and verified by 2 reviewers. The predefined research protocol was officially published in PROSPERO under the registration number CRD42023437068.
Results: There was a total of 21 trials that involved 41,594 participants. The analysis incorporated the sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), dipeptidyl peptidase-4 (DPP-4) inhibitors, metformin, sulfonylureas, and acarbose. The network meta-analysis revealed that GLP-1RAs were the sole agents that exhibited a significant reduction in the risk of major adverse cardiovascular events (risk ratio [RR], 0.83; 95% confidence interval [CI], 0.71 to 0.97). Significant preventive effect of SGLT2 inhibitors was observed in terms of hospitalization for heart failure (RR, 0.66; 95% CI, 0.57 to 0.77) and renal composite outcome (RR, 0.69; 95% CI, 0.53 to 0.89). Relative ranking evaluated by P-scores also demonstrated similar trends. Notably, the number of treatments needed decreased in most analytical findings among subpopulations as age increased.
Conclusions: Novel anti-diabetic agents should be prioritized as the preferred treatment options for elderly diabetic patients, particularly those with an elevated risk of cardiovascular disease or heart failure.
The relevance and importance to patients: Our study provides a comprehensive analysis of the body of evidence regarding the various benefits and drawbacks of all available antidiabetic medications. This information would empower medical decision-makers to adopt a personalized, precise, and tailored approach in their treatment strategies.