Type 2 Diabetes

Which Antidiabetic Drugs Are Associated With Improved Left Ventricular Function?

Data published in Cardiovascular Diabetology indicate that sodium glucose cotransporter 2 (SGLT-2) inhibitors “are superior to other [antidiabetic] drugs in pairwise comparisons” in improving left ventricular (LV) function among patients with type 2 diabetes and cardiovascular disease (CVD).

In their systematic review and meta-analysis, researchers compared the effects of various antidiabetic drugs, including SGLT-2 inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) agonists, metformin, sulfonylureas, and thiazolidinediones on left ventricular remodeling among patients with diabetes and CVD.

They analyzed randomized controlled trials and a small number of cohort studies that had recorded differences in the mean changes in LV echocardiographic parameters between treatment groups and control groups.

Ultimately, the researchers found that GLP-1 agonists were more significantly associated with improved LV ejection fraction, LV end-systolic volume and E/e′ compared with placebo. SGLT-2 inhibitors were more significantly associated with improved LV end-diastolic diameter and E/e′ compared with placebo, whereas DPP-4 inhibitors were more strongly associated with a negative impact on LV end-diastolic volume compared with placebo.

Specifically, the results of the analysis indicated that the difference in the mean change in LV ejection fraction between GLP-1 agonists and placebo in treatment effect was greater than 0, with a mean difference (MD) of 2.04%.

In addition, the researchers observed similar results for the difference in mean change in:

  • LV end-diastolic diameter between SGLT-2 inhibitors and placebo, with an MD of −3.3 mm.
  • LV end-systolic volume between GLP-1 agonists and placebo, with an MD of −4.39 ml.
  • E/e′ between GLP-1 agonists and placebo, with an MD of −1.05.
  • E/e′ between SGLT-2 inhibitors and placebo, with an MD of −1.91.

“GLP-1 agonist and SGLT-2 inhibitor treatment may serve as novel therapeutics for treating hyperglycemia and reducing cardiovascular comorbidities,” the researchers wrote.

—Christina Vogt

Zhang DP, Xu L, Wang LF, Wang HJ, Jiang F. Effects of antidiabetic drugs on left ventricular function/dysfunction: a systematic review and network meta-analysis. Cardiovasc Diabetol. 2020;19(10).