Generated Narrative: PublicationRecord 264329 version: 19; Last updated: 2026-06-26 20:08:48+0000 Profile: JournalArticleCitation ArtifactPublicationStatus: Active url: https://fevir.net/resources/PublicationRecord/264329 identifier: FEvIR Object Identifier/264329, https://pubmed.ncbi.nlm.nih.gov/37024129 title: 37024129 Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. status: Active author: Computable Publishing®: MEDLINE-to-FEvIR Converter: publisher: Computable Publishing LLC contact: support@computablepublishing.com description: This Citation Resource is referenced in an example for the EBMonFHIR Implementation Guide. UseContexts - Code Value[x] * Citation Classification Type: fevir-platform-use (FEvIR Platform Use) Medline Base copyright: Copyright the Authors else Computable Publishing LLC. Noncommercial use permitted with CC BY-NC-SA 4.0 (https://creativecommons.org/licenses/by-nc-sa/4.0/). Commercial use permitted as agreed in Terms of Use (https://fevir.net/termsofuse). approvalDate: 2023-04-10 lastReviewDate: 2025-06-23 classification type: Citation Source classifier: MEDLINE classification type: MEDLINE Citation Owner classifier: National Library of Medicine, Index Section currentState: Medline Citation Status of Medline, PubMed PublicationStatus of epublish statusDate activity: PubMed Pubstatus of Medline period: ?? --> 2023-04-10 06:42:00+0000 statusDate activity: PubMed Pubstatus of Entrez period: ?? --> 2023-04-06 20:43:00+0000 statusDate activity: PubMed Pubstatus of Pubmed period: ?? --> 2023-04-07 06:00:00+0000 statusDate activity: PubMed Pubstatus of PMC release period: ?? --> 2023-04-06 citedArtifact identifier: https://pubmed.ncbi.nlm.nih.gov/37024129, https://www.ncbi.nlm.nih.gov/pmc//PMC10077111, https://doi.org/10.1136/bmj-2022-074068 Titles - Type Language Text * Primary title English Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. Abstracts - Type Text Copyright * Primary human use OBJECTIVE: To compare the benefits and harms of drug treatments for adults with type 2 diabetes, adding non-steroidal mineralocorticoid receptor antagonists (including finerenone) and tirzepatide (a dual glucose dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonist) to previously existing treatment options. <AbstractText Label="DESIGN">Systematic review and network meta-analysis. <AbstractText Label="DATA SOURCES">Ovid Medline, Embase, and Cochrane Central up to 14 October 2022. <AbstractText Label="ELIGIBILITY CRITERIA FOR SELECTING STUDIES">Eligible randomised controlled trials compared drugs of interest in adults with type 2 diabetes. Eligible trials had a follow-up of 24 weeks or longer. Trials systematically comparing combinations of more than one drug treatment class with no drug, subgroup analyses of randomised controlled trials, and non-English language studies were deemed ineligible. Certainty of evidence was assessed following the GRADE (grading of recommendations, assessment, development and evaluation) approach. RESULTS: The analysis identified 816 trials with 471 038 patients, together evaluating 13 different drug classes; all subsequent estimates refer to the comparison with standard treatments. Sodium glucose cotransporter-2 (SGLT-2) inhibitors (odds ratio 0.88, 95% confidence interval 0.83 to 0.94; high certainty) and GLP-1 receptor agonists (0.88, 0.82 to 0.93; high certainty) reduce all cause death; non-steroidal mineralocorticoid receptor antagonists, so far tested only with finerenone in patients with chronic kidney disease, probably reduce mortality (0.89, 0.79 to 1.00; moderate certainty); other drugs may not. The study confirmed the benefits of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing cardiovascular death, non-fatal myocardial infarction, admission to hospital for heart failure, and end stage kidney disease. Finerenone probably reduces admissions to hospital for heart failure and end stage kidney disease, and possibly cardiovascular death. Only GLP-1 receptor agonists reduce non-fatal stroke; SGLT-2 inhibitors are superior to other drugs in reducing end stage kidney disease. GLP-1 receptor agonists and probably SGLT-2 inhibitors and tirzepatide improve quality of life. Reported harms were largely specific to drug class (eg, genital infections with SGLT-2 inhibitors, severe gastrointestinal adverse events with tirzepatide and GLP-1 receptor agonists, hyperkalaemia leading to admission to hospital with finerenone). Tirzepatide probably results in the largest reduction in body weight (mean difference -8.57 kg; moderate certainty). Basal insulin (mean difference 2.15 kg; moderate certainty) and thiazolidinediones (mean difference 2.81 kg; moderate certainty) probably result in the largest increases in body weight. Absolute benefits of SGLT-2 inhibitors, GLP-1 receptor agonists, and finerenone vary in people with type 2 diabetes, depending on baseline risks for cardiovascular and kidney outcomes (https://matchit.magicevidence.org/230125dist-diabetes). CONCLUSIONS: This network meta-analysis extends knowledge beyond confirming the substantial benefits with the use of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing adverse cardiovascular and kidney outcomes and death by adding information on finerenone and tirzepatide. These findings highlight the need for continuous assessment of scientific progress to introduce cutting edge updates in clinical practice guidelines for people with type 2 diabetes. <AbstractText Label="SYSTEMATIC REVIEW REGISTRATION">PROSPERO CRD42022325948. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ. relatesTo type: Cites classifier: Journal Article citation: Gregg EW, Jakicic JM, Blackburn G, et al. Look AHEAD Research Group . Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 2016;4:913-21. 10.1016/S2213-8587(16)30162-0. target: https://pubmed.ncbi.nlm.nih.gov/27595918/ relatesTo type: Cites classifier: Journal Article citation: Palmer SC, Tendal B, Mustafa RA, et al. Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. BMJ 2021;372:m4573. 10.1136/bmj.m4573. target: https://pubmed.ncbi.nlm.nih.gov/33441402/ relatesTo type: Cites classifier: Journal Article citation: Li S, Vandvik PO, Lytvyn L, et al. SGLT-2 inhibitors or GLP-1 receptor agonists for adults with type 2 diabetes: a clinical practice guideline. BMJ 2021;373:n1091. 10.1136/bmj.n1091. target: https://pubmed.ncbi.nlm.nih.gov/33975892/ relatesTo type: Cites classifier: Journal Article citation: Bakris GL, Agarwal R, Anker SD, et al. FIDELIO-DKD Investigators . Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med 2020;383:2219-29. 10.1056/NEJMoa2025845. target: https://pubmed.ncbi.nlm.nih.gov/33264825/ relatesTo type: Cites classifier: Journal Article citation: Pitt B, Filippatos G, Agarwal R, et al. FIGARO-DKD Investigators . Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med 2021;385:2252-63. 10.1056/NEJMoa2110956. target: https://pubmed.ncbi.nlm.nih.gov/34449181/ relatesTo type: Cites classifier: Journal Article citation: Rosenstock J, Wysham C, Frías JP, et al. Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1): a double-blind, randomised, phase 3 trial. Lancet 2021;398:143-55. 10.1016/S0140-6736(21)01324-6. target: https://pubmed.ncbi.nlm.nih.gov/34186022/ relatesTo type: Cites classifier: Journal Article citation: Frías JP, Davies MJ, Rosenstock J, et al. SURPASS-2 Investigators . Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. N Engl J Med 2021;385:503-15. 10.1056/NEJMoa2107519. target: https://pubmed.ncbi.nlm.nih.gov/34170647/ relatesTo type: Cites classifier: Journal Article citation: Ludvik B, Giorgino F, Jódar E, et al. Once-weekly tirzepatide versus once-daily insulin degludec as add-on to metformin with or without SGLT2 inhibitors in patients with type 2 diabetes (SURPASS-3): a randomised, open-label, parallel-group, phase 3 trial. Lancet 2021;398:583-98. 10.1016/S0140-6736(21)01443-4. target: https://pubmed.ncbi.nlm.nih.gov/34370970/ relatesTo type: Cites classifier: Journal Article citation: Del Prato S, Kahn SE, Pavo I, et al. SURPASS-4 Investigators . Tirzepatide versus insulin glargine in type 2 diabetes and increased cardiovascular risk (SURPASS-4): a randomised, open-label, parallel-group, multicentre, phase 3 trial. Lancet 2021;398:1811-24. 10.1016/S0140-6736(21)02188-7. target: https://pubmed.ncbi.nlm.nih.gov/34672967/ relatesTo type: Cites classifier: Journal Article citation: Dahl D, Onishi Y, Norwood P, et al. Effect of Subcutaneous Tirzepatide vs Placebo Added to Titrated Insulin Glargine on Glycemic Control in Patients With Type 2 Diabetes: The SURPASS-5 Randomized Clinical Trial. JAMA 2022;327:534-45. 10.1001/jama.2022.0078. target: https://pubmed.ncbi.nlm.nih.gov/35133415/ relatesTo type: Cites classifier: Journal Article citation: Rydén L, Standl E. After Metformin - Next Steps for Type 2 Diabetes with Low Cardiovascular Risk. N Engl J Med 2022;387:1136-8. 10.1056/NEJMe2210531. target: https://pubmed.ncbi.nlm.nih.gov/36130002/ relatesTo type: Cites classifier: Journal Article citation: Nathan DM, Lachin JM, Balasubramanyam A, et al. GRADE Study Research Group . Glycemia Reduction in Type 2 Diabetes - Glycemic Outcomes. N Engl J Med 2022;387:1063-74. 10.1056/NEJMoa2200433. target: https://pubmed.ncbi.nlm.nih.gov/36129996/ relatesTo type: Cites classifier: Journal Article citation: Nathan DM, Lachin JM, Bebu I, et al. GRADE Study Research Group . Glycemia Reduction in Type 2 Diabetes - Microvascular and Cardiovascular Outcomes. N Engl J Med 2022;387:1075-88. 10.1056/NEJMoa2200436. target: https://pubmed.ncbi.nlm.nih.gov/36129997/ relatesTo type: Cites classifier: Journal Article citation: Marx N, Ryden L, Brosius F, et al. Towards living guidelines on cardiorenal outcomes in diabetes: A pilot project of the Taskforce of the Guideline Workshop 2020. Diabetes Res Clin Pract 2021;177:108870. 10.1016/j.diabres.2021.108870. target: https://pubmed.ncbi.nlm.nih.gov/34044026/ relatesTo type: Cites classifier: Journal Article citation: Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. 10.1136/bmj.n71. target: https://pubmed.ncbi.nlm.nih.gov/33782057/ relatesTo type: Cites classifier: Journal Article citation: Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 2015;162:777-84. 10.7326/M14-2385. target: https://pubmed.ncbi.nlm.nih.gov/26030634/ relatesTo type: Cites citation: Guyatt G, Busse J. Methods Commentary: Risk of Bias in Randomized Trials 1. DistillerSR. 2011. https://www.distillersr.com/resources/methodological-resources/risk-of-bias-commentary. relatesTo type: Cites classifier: Journal Article citation: Levin A, Agarwal R, Herrington WG, et al. participant authors of the International Society of Nephrology’s 1st International Consensus Meeting on Defining Kidney Failure in Clinical Trials . International consensus definitions of clinical trial outcomes for kidney failure: 2020. Kidney Int 2020;98:849-59. 10.1016/j.kint.2020.07.013. target: https://pubmed.ncbi.nlm.nih.gov/32998816/ relatesTo type: Cites classifier: Journal Article citation: Rücker G. Network meta-analysis, electrical networks and graph theory. Res Synth Methods 2012;3:312-24. 10.1002/jrsm.1058. target: https://pubmed.ncbi.nlm.nih.gov/26053424/ relatesTo type: Cites classifier: Journal Article citation: Shi Q, Wang Y, Hao Q, et al. Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials. Lancet 2022;399:259-69. 10.1016/S0140-6736(21)01640-8. target: https://pubmed.ncbi.nlm.nih.gov/34895470/ relatesTo type: Cites classifier: Journal Article citation: Bhaumik DK, Amatya A, Normand S-L, et al. Meta-Analysis of Rare Binary Adverse Event Data. J Am Stat Assoc 2012;107:555-67. 10.1080/01621459.2012.664484. target: https://pubmed.ncbi.nlm.nih.gov/23734068/ relatesTo type: Cites classifier: Journal Article citation: Higgins JPT, Jackson D, Barrett JK, Lu G, Ades AE, White IR. Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Res Synth Methods 2012;3:98-110. 10.1002/jrsm.1044. target: https://pubmed.ncbi.nlm.nih.gov/26062084/ relatesTo type: Cites classifier: Journal Article citation: König J, Krahn U, Binder H. Visualizing the flow of evidence in network meta-analysis and characterizing mixed treatment comparisons. Stat Med 2013;32:5414-29. 10.1002/sim.6001. target: https://pubmed.ncbi.nlm.nih.gov/24123165/ relatesTo type: Cites classifier: Journal Article citation: Wiksten A, Hawkins N, Piepho H-P, Gsteiger S. Nonproportional Hazards in Network Meta-Analysis: Efficient Strategies for Model Building and Analysis. Value Health 2020;23:918-27. 10.1016/j.jval.2020.03.010. target: https://pubmed.ncbi.nlm.nih.gov/32762994/ relatesTo type: Cites classifier: Journal Article citation: Efthimiou O, Rücker G, Schwarzer G, Higgins JPT, Egger M, Salanti G. Network meta-analysis of rare events using the Mantel-Haenszel method. Stat Med 2019;38:2992-3012. 10.1002/sim.8158. target: https://pubmed.ncbi.nlm.nih.gov/30997687/ relatesTo type: Cites classifier: Journal Article citation: Schandelmaier S, Briel M, Varadhan R, et al. Development of the Instrument to assess the Credibility of Effect Modification Analyses (ICEMAN) in randomized controlled trials and meta-analyses. CMAJ 2020;192:E901-6. 10.1503/cmaj.200077. target: https://pubmed.ncbi.nlm.nih.gov/32778601/ relatesTo type: Cites classifier: Journal Article citation: Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011;64:401-6. 10.1016/j.jclinepi.2010.07.015. target: https://pubmed.ncbi.nlm.nih.gov/21208779/ relatesTo type: Cites classifier: Journal Article citation: Davies AL, Papakonstantinou T, Nikolakopoulou A, Rücker G, Galla T. Network meta-analysis and random walks. Stat Med 2022;41:2091-114. 10.1002/sim.9346. target: https://pubmed.ncbi.nlm.nih.gov/35293631/ relatesTo type: Cites classifier: Journal Article citation: Puhan MA, Schünemann HJ, Murad MH, et al. GRADE Working Group . A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ 2014;349:g5630. 10.1136/bmj.g5630. target: https://pubmed.ncbi.nlm.nih.gov/25252733/ relatesTo type: Cites classifier: Journal Article citation: Zeng L, Brignardello-Petersen R, Hultcrantz M, et al. GRADE guidelines 32: GRADE offers guidance on choosing targets of GRADE certainty of evidence ratings. J Clin Epidemiol 2021;137:163-75. 10.1016/j.jclinepi.2021.03.026. target: https://pubmed.ncbi.nlm.nih.gov/33857619/ relatesTo type: Cites classifier: Journal Article citation: Zeng L, Brignardello-Petersen R, Hultcrantz M, et al. GRADE Guidance 34: update on rating imprecision using a minimally contextualized approach. J Clin Epidemiol 2022;150:216-24. 10.1016/j.jclinepi.2022.07.014 target: https://pubmed.ncbi.nlm.nih.gov/35934265/ relatesTo type: Cites classifier: Journal Article citation: Brignardello-Petersen R, Florez ID, Izcovich A, et al. GRADE working group . GRADE approach to drawing conclusions from a network meta-analysis using a minimally contextualised framework. BMJ 2020;371:m3900. 10.1136/bmj.m3900. target: https://pubmed.ncbi.nlm.nih.gov/33177059/ relatesTo type: Cites classifier: Journal Article citation: Phillips MR, Sadeghirad B, Busse JW, et al. Development and design validation of a novel network meta-analysis presentation tool for multiple outcomes: a qualitative descriptive study. BMJ Open 2022;12:e056400. 10.1136/bmjopen-2021-056400. target: https://pubmed.ncbi.nlm.nih.gov/35688599/ relatesTo type: Cites classifier: Journal Article citation: Buchan TA, Malik A, Chan C, et al. Predictive models for cardiovascular and kidney outcomes in patients with type 2 diabetes: systematic review and meta-analyses. Heart 2021;107:1962-73. 10.1136/heartjnl-2021-319243. target: https://pubmed.ncbi.nlm.nih.gov/33833070/ relatesTo type: Cites classifier: Journal Article citation: Wright AK, Carr MJ, Kontopantelis E, et al. Primary Prevention of Cardiovascular and Heart Failure Events With SGLT2 Inhibitors, GLP-1 Receptor Agonists, and Their Combination in Type 2 Diabetes. Diabetes Care 2022;45:909-18. 10.2337/dc21-1113. target: https://pubmed.ncbi.nlm.nih.gov/35100355/ relatesTo type: Cites classifier: Journal Article citation: Rossing P, Anker SD, Filippatos G, et al. FIDELIO-DKD and FIGARO-DKD Investigators . Finerenone in Patients With Chronic Kidney Disease and Type 2 Diabetes by Sodium-Glucose Cotransporter 2 Inhibitor Treatment: The FIDELITY Analysis. Diabetes Care 2022;45:2991-8. 10.2337/dc22-0294. target: https://pubmed.ncbi.nlm.nih.gov/35972218/ relatesTo type: Cites classifier: Journal Article citation: Sato N, Ajioka M, Yamada T, et al. ARTS-HF Japan study group . A Randomized Controlled Study of Finerenone vs. Eplerenone in Japanese Patients With Worsening Chronic Heart Failure and Diabetes and/or Chronic Kidney Disease. Circ J 2016;80:1113-22. 10.1253/circj.CJ-16-0122. target: https://pubmed.ncbi.nlm.nih.gov/27074824/ relatesTo type: Cites classifier: Journal Article citation: Ruilope LM, Pitt B, Anker SD, et al. Kidney outcomes with finerenone: an analysis from the FIGARO-DKD study. Nephrol Dial Transplant 2023;38:372-83. target: https://pubmed.ncbi.nlm.nih.gov/35451488/ relatesTo type: Cites citation: Bayer. A Multicenter, Randomized, Double-blind, Parallel-group, Placebo-controlled Study to Evaluate the Efficacy and Safety of Finerenone on Morbidity and Mortality in Participants With Heart Failure (NYHA II-IV) and Left Ventricular Ejection Fraction ≥ 40% (LVEF ≥ 40%). Clinicaltrials.gov. 2022. https://clinicaltrials.gov/ct2/show/NCT04435626. relatesTo type: Cites classifier: Journal Article citation: Hundemer GL, Sood MM. Hyperkalemia with RAAS inhibition: Mechanism, clinical significance, and management. Pharmacol Res 2021;172:105835. 10.1016/j.phrs.2021.105835. target: https://pubmed.ncbi.nlm.nih.gov/34438065/ relatesTo type: Cites citation: Eli Lilly and Company. The Effect of Tirzepatide Versus Dulaglutide on Major Adverse Cardiovascular Events in Patients With Type 2 Diabetes (SURPASS-CVOT). clinicaltrials.gov 2022. https://clinicaltrials.gov/ct2/show/NCT04255433. relatesTo type: Cites classifier: Journal Article citation: Deacon CF. Dipeptidyl peptidase 4 inhibitors in the treatment of type 2 diabetes mellitus. Nat Rev Endocrinol 2020;16:642-53. 10.1038/s41574-020-0399-8. target: https://pubmed.ncbi.nlm.nih.gov/32929230/ relatesTo type: Cites classifier: Journal Article citation: Liu J, Li L, Li S, et al. Sodium-glucose co-transporter-2 inhibitors and the risk of diabetic ketoacidosis in patients with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab 2020;22:1619-27. 10.1111/dom.14075. target: https://pubmed.ncbi.nlm.nih.gov/32364674/ relatesTo type: Cites classifier: Journal Article citation: Lin C, Zhu X, Cai X, et al. SGLT2 inhibitors and lower limb complications: an updated meta-analysis. Cardiovasc Diabetol 2021;20:91. 10.1186/s12933-021-01276-9. target: https://pubmed.ncbi.nlm.nih.gov/33910574/ publicationForm publishedIn type: Periodical identifier: Electronic ISSN Type/1756-1833, ISOAbbreviation/BMJ, ISSN Linking/0959-8138, Medline Title Abbreviation/BMJ, NLM Unique ID/8900488 title: BMJ (Clinical research ed.) publisherLocation: England citedMedium: Internet volume: 381 articleDate: 2023-04-06 publicationDateText: 2023-Apr-06 pageString: e074068 publicationForm citedMedium: Internet without issue articleDate: 2023-04-06 webLocation classifier: Abstract url: https://pubmed.ncbi.nlm.nih.gov/37024129/ webLocation classifier: DOI Based url: https://doi.org/10.1136/bmj-2022-074068 classification type: Publishing Model classifier: Electronic classification type: Chemical classifier: Sodium-Glucose Transporter 2 Inhibitors, Mineralocorticoid Receptor Antagonists, Glucagon-Like Peptide-1 Receptor classification type: MeSH heading artifactAssessment: ArtifactAssessment: artifact[x] = this resource classification type: Publication type classifier: Systematic Review, Journal Article, Network Meta-Analysis classification type: Knowledge Artifact Type classifier: Journal Article artifactAssessment: Classifier added by Computable Publishing LLC classification type: Citation subset classifier: IM contributorship complete: true entry contributor: Shi Q forenameInitials: Q affiliation: Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China. entry contributor: Nong K forenameInitials: K affiliation: Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China. entry contributor: Vandvik PO forenameInitials: PO affiliation: Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway. entry contributor: Guyatt GH forenameInitials: GH affiliation: Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada. entry contributor: Schnell O forenameInitials: O affiliation: Forschergruppe Diabetes eV at the Helmholtz Centre, Munich-Neuherberg, Germany. entry contributor: Rydén L forenameInitials: L affiliation: Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden. entry contributor: Marx N forenameInitials: N affiliation: Clinic for Cardiology, Angiology, and Intensive Care Medicine, RWTH Aachen University, University Hospital Aachen, Aachen, Germany. entry contributor: Brosius FC forenameInitials: FC affiliation: Division of Nephrology, University of Arizona College of Medicine Tucson, Tucson, AZ, USA. entry contributor: Mustafa RA forenameInitials: RA affiliation: Department of Internal Medicine, Division of Nephrology and Hypertension, University of Kansas, Kansas City, MI, USA. entry contributor: Agarwal A forenameInitials: A affiliation: Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada. Department of Medicine, McMaster University, Hamilton, ON, Canada. entry contributor: Zou X forenameInitials: X affiliation: Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China. entry contributor: Mao Y forenameInitials: Y affiliation: Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China. entry contributor: Asadollahifar A forenameInitials: A affiliation: Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. entry contributor: Chowdhury SR forenameInitials: SR affiliation: Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada. entry contributor: Zhai C forenameInitials: C affiliation: Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China. entry contributor: Gupta S forenameInitials: S affiliation: Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada. entry contributor: Gao Y forenameInitials: Y affiliation: Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada. Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China. entry contributor: Lima JP forenameInitials: JP affiliation: Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada. entry contributor: Numata K forenameInitials: K affiliation: Department of Emergency Medicine, St Marianna University School of Medicine, Kawasaki, Japan. entry contributor: Qiao Z forenameInitials: Z affiliation: West China School of Medicine, Sichuan University, Chengdu, China. entry contributor: Fan Q forenameInitials: Q affiliation: Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China. entry contributor: Yang Q forenameInitials: Q affiliation: Department of Nephrology, National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China. entry contributor: Jin Y forenameInitials: Y affiliation: Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China. entry contributor: Ge L forenameInitials: L affiliation: Evidence-Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China. entry contributor: Yang Q forenameInitials: Q affiliation: Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China. entry contributor: Zhu H forenameInitials: H affiliation: Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. entry contributor: Yang F forenameInitials: F affiliation: Department of Endocrinology and Metabolism, Chengdu Fifth People's Hospital, Chengdu, China. entry contributor: Chen Z forenameInitials: Z affiliation: Evidence-Based Medicine Centre, Tianjin University of Traditional Chinese Medicine, Tianjin, China. entry contributor: Lu X forenameInitials: X affiliation: Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China. entry contributor: He S forenameInitials: S affiliation: Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China. entry contributor: Chen X forenameInitials: X affiliation: Department of Endocrinology and Metabolism, First People's Hospital of Shuangliu District, Chengdu, China. entry contributor: Lyu X forenameInitials: X affiliation: Department of Radiology, West China Hospital, Sichuan University, Chengdu, China. entry contributor: An X forenameInitials: X affiliation: Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China. entry contributor: Chen Y forenameInitials: Y affiliation: Evidence-Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China. entry contributor: Hao Q forenameInitials: Q affiliation: School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada. entry contributor: Standl E forenameInitials: E affiliation: Forschergruppe Diabetes eV at the Helmholtz Centre, Munich-Neuherberg, Germany. entry contributor: Siemieniuk R forenameInitials: R affiliation: Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada. entry contributor: Agoritsas T forenameInitials: T affiliation: Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada. Division of General Internal Medicine, Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland. entry contributor: Tian H forenameInitials: H affiliation: Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China. entry contributor: Li S forenameInitials: S affiliation: Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China lisheyu@gmail.com. Generated Narrative: Practitioner #contributor0 identifier: ORCID/0000-0003-4299-5889 name: Qingyang Shi Generated Narrative: Practitioner #contributor1 name: Kailei Nong Generated Narrative: Practitioner #contributor2 name: Per Olav Vandvik Generated Narrative: Practitioner #contributor3 name: Gordon H Guyatt Generated Narrative: Practitioner #contributor4 name: Oliver Schnell Generated Narrative: Practitioner #contributor5 name: Lars Rydén Generated Narrative: Practitioner #contributor6 name: Nikolaus Marx Generated Narrative: Practitioner #contributor7 name: Frank C Brosius Generated Narrative: Practitioner #contributor8 name: Reem A Mustafa Generated Narrative: Practitioner #contributor9 name: Arnav Agarwal Generated Narrative: Practitioner #contributor10 name: Xinyu Zou Generated Narrative: Practitioner #contributor11 name: Yunhe Mao Generated Narrative: Practitioner #contributor12 name: Aminreza Asadollahifar Generated Narrative: Practitioner #contributor13 name: Saifur Rahman Chowdhury Generated Narrative: Practitioner #contributor14 name: Chunjuan Zhai Generated Narrative: Practitioner #contributor15 name: Sana Gupta Generated Narrative: Practitioner #contributor16 name: Ya Gao Generated Narrative: Practitioner #contributor17 name: João Pedro Lima Generated Narrative: Practitioner #contributor18 name: Kenji Numata Generated Narrative: Practitioner #contributor19 name: Zhi Qiao Generated Narrative: Practitioner #contributor20 name: Qinlin Fan Generated Narrative: Practitioner #contributor21 name: Qinbo Yang Generated Narrative: Practitioner #contributor22 name: Yinghui Jin Generated Narrative: Practitioner #contributor23 name: Long Ge Generated Narrative: Practitioner #contributor24 name: Qiuyu Yang Generated Narrative: Practitioner #contributor25 name: Hongfei Zhu Generated Narrative: Practitioner #contributor26 name: Fan Yang Generated Narrative: Practitioner #contributor27 name: Zhe Chen Generated Narrative: Practitioner #contributor28 name: Xi Lu Generated Narrative: Practitioner #contributor29 name: Siyu He Generated Narrative: Practitioner #contributor30 name: Xiangyang Chen Generated Narrative: Practitioner #contributor31 name: Xiafei Lyu Generated Narrative: Practitioner #contributor32 name: Xingxing An Generated Narrative: Practitioner #contributor33 name: Yaolong Chen Generated Narrative: Practitioner #contributor34 name: Qiukui Hao Generated Narrative: Practitioner #contributor35 name: Eberhard Standl Generated Narrative: Practitioner #contributor36 name: Reed Siemieniuk Generated Narrative: Practitioner #contributor37 name: Thomas Agoritsas Generated Narrative: Practitioner #contributor38 name: Haoming Tian Generated Narrative: Practitioner #contributor39 identifier: ORCID/0000-0003-0060-0287 name: Sheyu Li Generated Narrative: ArtifactAssessment #meshHeading0 artifact: PublicationRecord 37024129 Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. content type: components (if present) include qualifier codings classifier: Adult freeToShare: true Components - Type Classifier * qualifier is not a major topic content type: components (if present) include qualifier codings classifier: Humans freeToShare: true Components - Type Classifier * qualifier is not a major topic content type: components (if present) include qualifier codings classifier: Diabetes Mellitus, Type 2 freeToShare: true component type: qualifier classifier: is Major topic component type: qualifier classifier: drug therapy Components - Type Classifier * is Major topic No content type: components (if present) include qualifier codings classifier: Sodium-Glucose Transporter 2 Inhibitors freeToShare: true component type: qualifier classifier: is Major topic component type: qualifier classifier: adverse effects Components - Type Classifier * is Major topic No content type: components (if present) include qualifier codings classifier: Mineralocorticoid Receptor Antagonists freeToShare: true component type: qualifier classifier: is not a major topic component type: qualifier classifier: adverse effects Components - Type Classifier * is Major topic No content type: components (if present) include qualifier codings classifier: Glucagon-Like Peptide-1 Receptor freeToShare: true component type: qualifier classifier: is not a major topic component type: qualifier classifier: therapeutic use Components - Type Classifier * is Major topic No content type: components (if present) include qualifier codings classifier: Quality of Life freeToShare: true Components - Type Classifier * qualifier is not a major topic content type: components (if present) include qualifier codings classifier: Kidney Failure, Chronic freeToShare: true Components - Type Classifier * qualifier is Major topic content type: components (if present) include qualifier codings classifier: Heart Failure freeToShare: true component type: qualifier classifier: is Major topic component type: qualifier classifier: drug therapy Components - Type Classifier * is Major topic No content type: components (if present) include qualifier codings classifier: Randomized Controlled Trials as Topic freeToShare: true Components - Type Classifier * qualifier is not a major topic
components (if present) include qualifier codings
37024129 Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials.
Computable Publishing®: MEDLINE-to-FEvIR Converter
This Citation Resource is referenced in an example for the EBMonFHIR Implementation Guide.
Copyright the Authors else Computable Publishing LLC. Noncommercial use permitted with CC BY-NC-SA 4.0 (https://creativecommons.org/licenses/by-nc-sa/4.0/). Commercial use permitted as agreed in Terms of Use (https://fevir.net/termsofuse).
National Library of Medicine, Index Section
Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials.
**OBJECTIVE:** To compare the benefits and harms of drug treatments for adults with type 2 diabetes, adding non-steroidal mineralocorticoid receptor antagonists (including finerenone) and tirzepatide (a dual glucose dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonist) to previously existing treatment options. <AbstractText Label="DESIGN">Systematic review and network meta-analysis. <AbstractText Label="DATA SOURCES">Ovid Medline, Embase, and Cochrane Central up to 14 October 2022. <AbstractText Label="ELIGIBILITY CRITERIA FOR SELECTING STUDIES">Eligible randomised controlled trials compared drugs of interest in adults with type 2 diabetes. Eligible trials had a follow-up of 24 weeks or longer. Trials systematically comparing combinations of more than one drug treatment class with no drug, subgroup analyses of randomised controlled trials, and non-English language studies were deemed ineligible. Certainty of evidence was assessed following the GRADE (grading of recommendations, assessment, development and evaluation) approach. **RESULTS:** The analysis identified 816 trials with 471 038 patients, together evaluating 13 different drug classes; all subsequent estimates refer to the comparison with standard treatments. Sodium glucose cotransporter-2 (SGLT-2) inhibitors (odds ratio 0.88, 95% confidence interval 0.83 to 0.94; high certainty) and GLP-1 receptor agonists (0.88, 0.82 to 0.93; high certainty) reduce all cause death; non-steroidal mineralocorticoid receptor antagonists, so far tested only with finerenone in patients with chronic kidney disease, probably reduce mortality (0.89, 0.79 to 1.00; moderate certainty); other drugs may not. The study confirmed the benefits of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing cardiovascular death, non-fatal myocardial infarction, admission to hospital for heart failure, and end stage kidney disease. Finerenone probably reduces admissions to hospital for heart failure and end stage kidney disease, and possibly cardiovascular death. Only GLP-1 receptor agonists reduce non-fatal stroke; SGLT-2 inhibitors are superior to other drugs in reducing end stage kidney disease. GLP-1 receptor agonists and probably SGLT-2 inhibitors and tirzepatide improve quality of life. Reported harms were largely specific to drug class (eg, genital infections with SGLT-2 inhibitors, severe gastrointestinal adverse events with tirzepatide and GLP-1 receptor agonists, hyperkalaemia leading to admission to hospital with finerenone). Tirzepatide probably results in the largest reduction in body weight (mean difference -8.57 kg; moderate certainty). Basal insulin (mean difference 2.15 kg; moderate certainty) and thiazolidinediones (mean difference 2.81 kg; moderate certainty) probably result in the largest increases in body weight. Absolute benefits of SGLT-2 inhibitors, GLP-1 receptor agonists, and finerenone vary in people with type 2 diabetes, depending on baseline risks for cardiovascular and kidney outcomes (https://matchit.magicevidence.org/230125dist-diabetes). **CONCLUSIONS:** This network meta-analysis extends knowledge beyond confirming the substantial benefits with the use of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing adverse cardiovascular and kidney outcomes and death by adding information on finerenone and tirzepatide. These findings highlight the need for continuous assessment of scientific progress to introduce cutting edge updates in clinical practice guidelines for people with type 2 diabetes. <AbstractText Label="SYSTEMATIC REVIEW REGISTRATION">PROSPERO CRD42022325948.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.
Gregg EW, Jakicic JM, Blackburn G, et al. Look AHEAD Research Group . Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 2016;4:913-21. 10.1016/S2213-8587(16)30162-0.
Palmer SC, Tendal B, Mustafa RA, et al. Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. BMJ 2021;372:m4573. 10.1136/bmj.m4573.
Li S, Vandvik PO, Lytvyn L, et al. SGLT-2 inhibitors or GLP-1 receptor agonists for adults with type 2 diabetes: a clinical practice guideline. BMJ 2021;373:n1091. 10.1136/bmj.n1091.
Bakris GL, Agarwal R, Anker SD, et al. FIDELIO-DKD Investigators . Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med 2020;383:2219-29. 10.1056/NEJMoa2025845.
Pitt B, Filippatos G, Agarwal R, et al. FIGARO-DKD Investigators . Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med 2021;385:2252-63. 10.1056/NEJMoa2110956.
Rosenstock J, Wysham C, Frías JP, et al. Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1): a double-blind, randomised, phase 3 trial. Lancet 2021;398:143-55. 10.1016/S0140-6736(21)01324-6.
Frías JP, Davies MJ, Rosenstock J, et al. SURPASS-2 Investigators . Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. N Engl J Med 2021;385:503-15. 10.1056/NEJMoa2107519.
Ludvik B, Giorgino F, Jódar E, et al. Once-weekly tirzepatide versus once-daily insulin degludec as add-on to metformin with or without SGLT2 inhibitors in patients with type 2 diabetes (SURPASS-3): a randomised, open-label, parallel-group, phase 3 trial. Lancet 2021;398:583-98. 10.1016/S0140-6736(21)01443-4.
Del Prato S, Kahn SE, Pavo I, et al. SURPASS-4 Investigators . Tirzepatide versus insulin glargine in type 2 diabetes and increased cardiovascular risk (SURPASS-4): a randomised, open-label, parallel-group, multicentre, phase 3 trial. Lancet 2021;398:1811-24. 10.1016/S0140-6736(21)02188-7.
Dahl D, Onishi Y, Norwood P, et al. Effect of Subcutaneous Tirzepatide vs Placebo Added to Titrated Insulin Glargine on Glycemic Control in Patients With Type 2 Diabetes: The SURPASS-5 Randomized Clinical Trial. JAMA 2022;327:534-45. 10.1001/jama.2022.0078.
Rydén L, Standl E. After Metformin - Next Steps for Type 2 Diabetes with Low Cardiovascular Risk. N Engl J Med 2022;387:1136-8. 10.1056/NEJMe2210531.
Nathan DM, Lachin JM, Balasubramanyam A, et al. GRADE Study Research Group . Glycemia Reduction in Type 2 Diabetes - Glycemic Outcomes. N Engl J Med 2022;387:1063-74. 10.1056/NEJMoa2200433.
Nathan DM, Lachin JM, Bebu I, et al. GRADE Study Research Group . Glycemia Reduction in Type 2 Diabetes - Microvascular and Cardiovascular Outcomes. N Engl J Med 2022;387:1075-88. 10.1056/NEJMoa2200436.
Marx N, Ryden L, Brosius F, et al. Towards living guidelines on cardiorenal outcomes in diabetes: A pilot project of the Taskforce of the Guideline Workshop 2020. Diabetes Res Clin Pract 2021;177:108870. 10.1016/j.diabres.2021.108870.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. 10.1136/bmj.n71.
Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 2015;162:777-84. 10.7326/M14-2385.
Guyatt G, Busse J. Methods Commentary: Risk of Bias in Randomized Trials 1. DistillerSR. 2011. https://www.distillersr.com/resources/methodological-resources/risk-of-bias-commentary.
Levin A, Agarwal R, Herrington WG, et al. participant authors of the International Society of Nephrology’s 1st International Consensus Meeting on Defining Kidney Failure in Clinical Trials . International consensus definitions of clinical trial outcomes for kidney failure: 2020. Kidney Int 2020;98:849-59. 10.1016/j.kint.2020.07.013.
Rücker G. Network meta-analysis, electrical networks and graph theory. Res Synth Methods 2012;3:312-24. 10.1002/jrsm.1058.
Shi Q, Wang Y, Hao Q, et al. Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials. Lancet 2022;399:259-69. 10.1016/S0140-6736(21)01640-8.
Bhaumik DK, Amatya A, Normand S-L, et al. Meta-Analysis of Rare Binary Adverse Event Data. J Am Stat Assoc 2012;107:555-67. 10.1080/01621459.2012.664484.
Higgins JPT, Jackson D, Barrett JK, Lu G, Ades AE, White IR. Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Res Synth Methods 2012;3:98-110. 10.1002/jrsm.1044.
König J, Krahn U, Binder H. Visualizing the flow of evidence in network meta-analysis and characterizing mixed treatment comparisons. Stat Med 2013;32:5414-29. 10.1002/sim.6001.
Wiksten A, Hawkins N, Piepho H-P, Gsteiger S. Nonproportional Hazards in Network Meta-Analysis: Efficient Strategies for Model Building and Analysis. Value Health 2020;23:918-27. 10.1016/j.jval.2020.03.010.
Efthimiou O, Rücker G, Schwarzer G, Higgins JPT, Egger M, Salanti G. Network meta-analysis of rare events using the Mantel-Haenszel method. Stat Med 2019;38:2992-3012. 10.1002/sim.8158.
Schandelmaier S, Briel M, Varadhan R, et al. Development of the Instrument to assess the Credibility of Effect Modification Analyses (ICEMAN) in randomized controlled trials and meta-analyses. CMAJ 2020;192:E901-6. 10.1503/cmaj.200077.
Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011;64:401-6. 10.1016/j.jclinepi.2010.07.015.
Davies AL, Papakonstantinou T, Nikolakopoulou A, Rücker G, Galla T. Network meta-analysis and random walks. Stat Med 2022;41:2091-114. 10.1002/sim.9346.
Puhan MA, Schünemann HJ, Murad MH, et al. GRADE Working Group . A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ 2014;349:g5630. 10.1136/bmj.g5630.
Zeng L, Brignardello-Petersen R, Hultcrantz M, et al. GRADE guidelines 32: GRADE offers guidance on choosing targets of GRADE certainty of evidence ratings. J Clin Epidemiol 2021;137:163-75. 10.1016/j.jclinepi.2021.03.026.
Zeng L, Brignardello-Petersen R, Hultcrantz M, et al. GRADE Guidance 34: update on rating imprecision using a minimally contextualized approach. J Clin Epidemiol 2022;150:216-24. 10.1016/j.jclinepi.2022.07.014
Brignardello-Petersen R, Florez ID, Izcovich A, et al. GRADE working group . GRADE approach to drawing conclusions from a network meta-analysis using a minimally contextualised framework. BMJ 2020;371:m3900. 10.1136/bmj.m3900.
Phillips MR, Sadeghirad B, Busse JW, et al. Development and design validation of a novel network meta-analysis presentation tool for multiple outcomes: a qualitative descriptive study. BMJ Open 2022;12:e056400. 10.1136/bmjopen-2021-056400.
Buchan TA, Malik A, Chan C, et al. Predictive models for cardiovascular and kidney outcomes in patients with type 2 diabetes: systematic review and meta-analyses. Heart 2021;107:1962-73. 10.1136/heartjnl-2021-319243.
Wright AK, Carr MJ, Kontopantelis E, et al. Primary Prevention of Cardiovascular and Heart Failure Events With SGLT2 Inhibitors, GLP-1 Receptor Agonists, and Their Combination in Type 2 Diabetes. Diabetes Care 2022;45:909-18. 10.2337/dc21-1113.
Rossing P, Anker SD, Filippatos G, et al. FIDELIO-DKD and FIGARO-DKD Investigators . Finerenone in Patients With Chronic Kidney Disease and Type 2 Diabetes by Sodium-Glucose Cotransporter 2 Inhibitor Treatment: The FIDELITY Analysis. Diabetes Care 2022;45:2991-8. 10.2337/dc22-0294.
Sato N, Ajioka M, Yamada T, et al. ARTS-HF Japan study group . A Randomized Controlled Study of Finerenone vs. Eplerenone in Japanese Patients With Worsening Chronic Heart Failure and Diabetes and/or Chronic Kidney Disease. Circ J 2016;80:1113-22. 10.1253/circj.CJ-16-0122.
Ruilope LM, Pitt B, Anker SD, et al. Kidney outcomes with finerenone: an analysis from the FIGARO-DKD study. Nephrol Dial Transplant 2023;38:372-83.
Bayer. A Multicenter, Randomized, Double-blind, Parallel-group, Placebo-controlled Study to Evaluate the Efficacy and Safety of Finerenone on Morbidity and Mortality in Participants With Heart Failure (NYHA II-IV) and Left Ventricular Ejection Fraction ≥ 40% (LVEF ≥ 40%). Clinicaltrials.gov. 2022. https://clinicaltrials.gov/ct2/show/NCT04435626.
Hundemer GL, Sood MM. Hyperkalemia with RAAS inhibition: Mechanism, clinical significance, and management. Pharmacol Res 2021;172:105835. 10.1016/j.phrs.2021.105835.
Eli Lilly and Company. The Effect of Tirzepatide Versus Dulaglutide on Major Adverse Cardiovascular Events in Patients With Type 2 Diabetes (SURPASS-CVOT). clinicaltrials.gov 2022. https://clinicaltrials.gov/ct2/show/NCT04255433.
Deacon CF. Dipeptidyl peptidase 4 inhibitors in the treatment of type 2 diabetes mellitus. Nat Rev Endocrinol 2020;16:642-53. 10.1038/s41574-020-0399-8.
Liu J, Li L, Li S, et al. Sodium-glucose co-transporter-2 inhibitors and the risk of diabetic ketoacidosis in patients with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab 2020;22:1619-27. 10.1111/dom.14075.
Lin C, Zhu X, Cai X, et al. SGLT2 inhibitors and lower limb complications: an updated meta-analysis. Cardiovasc Diabetol 2021;20:91. 10.1186/s12933-021-01276-9.
Classifier added by Computable Publishing LLC
Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China.
Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway.
Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada.
Forschergruppe Diabetes eV at the Helmholtz Centre, Munich-Neuherberg, Germany.
Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden.
Clinic for Cardiology, Angiology, and Intensive Care Medicine, RWTH Aachen University, University Hospital Aachen, Aachen, Germany.
Division of Nephrology, University of Arizona College of Medicine Tucson, Tucson, AZ, USA.
Department of Internal Medicine, Division of Nephrology and Hypertension, University of Kansas, Kansas City, MI, USA.
Department of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China.
Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
Department of Emergency Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
West China School of Medicine, Sichuan University, Chengdu, China.
Department of Nephrology, National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
Evidence-Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China.
Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China.
Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.
Department of Endocrinology and Metabolism, Chengdu Fifth People's Hospital, Chengdu, China.
Evidence-Based Medicine Centre, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Endocrinology and Metabolism, First People's Hospital of Shuangliu District, Chengdu, China.
Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
Division of General Internal Medicine, Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.
Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China lisheyu@gmail.com.