Diabetes mellitus and atrial fibrillation-from pathophysiology to treatment

Table 2 The effect of antidiabetic medication in atrial fibrillation

Ref.	Medication	Study design	Effect
Chang et al[51]	Metformin	Non-RCT	Lower risk of new-onset AF (HR: 0.81, 95%CI: 0.76-0.86, P < 0.0001)
Zhang et al[55]	TZD	MA	Approximately 30% lower risk of developing AF compared to controls, only in observational studies
Chang et al[60]	DPP4i	Non-RCT	DPP4i users were associated with a lower risk of new-onset AF compared with non-DPP4i
Monami et al[66]	GLP1-RA	MA	No effect on AF incidence (OR: 0.87, 95%CI: 0.71-1.05, P = 0.15)
Zelniker et al[71]	SGLT2i	RCT	Reduced AF risk (HR: 0.81, 95%CI: 0.68-0.95, P = 0.009)
Fernandes et al[73]	SGLT2i	MA	Reduced incidence of atrial arrhythmias (OR: 0.81, 95%CI: 0.69-0.95, P = 0.008)
Engström et al[77]	SGLT2i	Non-RCT	SGLT2i modestly reduced AF risk compared to GLP1-RA (adjusted HR: 0.89, 95%CI: 0.81-0.96)
Lee et al[80]	SGLT2i	Non-RCT	Lower risk of incident AF compared to DPP4i (HR: 0.68, 95%CI: 0.56, 0.83, P = 0.0001)

AF: Atrial fibrillation; RCT: Randomized controlled trial; HR: Hazard ratio; CI: Confidence interval; TZD: Thiazolidinedione; MA: Meta-analysis; DPP4i: Dipeptyl peptidase 4 inhibitors; GLP1-RA: Glucagon-like peptide-1 receptor agonist; OR: Odds ratio; SGLT2i: Sodium-glucose cotransporter-2 inhibitors.