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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Comparative efficacy of sodium glucose cotransporter-2 inhibitors in the management of type 2 diabetes mellitus: A real-world experience
Lubna Islam, Dhanya Jose, Mohammed Alkhalifah, Dania Blaibel, Vishnu Chandrabalan, Joseph M Pappachan
Lubna Islam, Mohammed Alkhalifah, Dania Blaibel, Joseph M Pappachan, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
Dhanya Jose, Department of Community Medicine, Goa Medical College, Goa 403202, India
Mohammed Alkhalifah, Department of Family Medicine, King Faisal Specialist Hospital, Riyadh 11564, Saudi Arabia
Vishnu Chandrabalan, Department of Data Science, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
Joseph M Pappachan, Faculty of Science, Manchester Metropolitan University, All Saints Building, Manchester M15 6BH, United Kingdom
Joseph M Pappachan, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
Co-first authors: Lubna Islam and Dhanya Jose.
Author contributions: Islam L, Alkhalifah M, and Blaibel D collected the clinical data; Jose D performed the statistical analysis and wrote the initial draft of the manuscript; Islam L performed the literature review, and interpretation of relevant data following statistical analysis; Islam L and Jose D helped revision and figure preparation for the paper and share the first authorship of the work; Alkhalifah M, Blaibel D, and Chandrabalan V contributed to the work with additional literature review and revision of the article critically for important intellectual content; Chandrabalan V also procured the patient data from the hospital electronic records; Pappachan JM contributed to the conceptual design of the paper and critically supervised the whole drafting, literature review, revision and modifications of the paper including figure construction and is the final author; and all authors have read and approved the final version of the manuscript.
Institutional review board statement: The study was approved by the institutional research committee (No: KB/PB/SE-387/2022).
Informed consent statement: This is a retrospective cohort study performed by review of participants’ electronic clinical records only and therefore, patient consent was not necessary and was not obtained.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Authors are happy to share the data on request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Joseph M Pappachan, MD, FRCP, Academic Editor, Consultant Endocrinologist, Professor, Senior Researcher, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston PR2 9HT, United Kingdom.
drpappachan@yahoo.co.in
Received: October 28, 2023
Peer-review started: October 28, 2023
First decision: December 29, 2023
Revised: January 2, 2024
Accepted: February 18, 2024
Article in press: February 18, 2024
Published online: March 15, 2024
Processing time: 138 Days and 12.8 Hours
ARTICLE HIGHLIGHTS
Research background
Sodium glucose cotransporter-2 inhibitors (SGLT-2i) are antidiabetic medications with moderate efficacy in glycemic control, and a potential for weight loss through their glycosuric effects, which are helpful for patients with diabesity - diabetes consequent to obesity. Marked cardiovascular and reno-protective effects with the use of SGLT-2i were proven by multiple randomised controlled trials (RCTs), observational studies and various systematic reviews.
Research motivation
Head-to-head comparison of the real-world data on the comparative efficacy and safety of individual SGLT-2i medications is rather sparse and needs more reports to appraise the benefits shown by the above studies.
Research objectives
To procure the comparative efficacy, safety, and adverse effect profiles of SGLT2i drugs in the clinical practice settings to make better therapeutic decision making as RCTs and prospective observational studies are often biased with rigorous monitoring of patients and the study results that wouldn’t always reflect the real-world medical practice.
Research methods
We evaluated the comparative efficacy data of 3 SGLT-2i drugs (dapagliflozin, canagliflozin, and empagliflozin) at full doses, used for treating patients with type 2 diabetes mellitus (T2DM) only. Reduction of glycated hemoglobin, body weight, blood pressure, and urine albumin creatinine ratio were recorded, and the adverse effects were documented retrospectively from the clinical records.
Research results
This real-world data from 467 patients with T2DM showed remarkable improvements in diabesity and cardiometabolic outcomes with all the three SGLT-2i agents with a tendency for renal protection (improvement of albuminuria) in those on canagliflozin. These drugs are reasonably safe with acceptably mild side effects profiles when used judiciously in patients with diabesity.
Research conclusions
We found that SGLT-2i class of medications are very useful for the management of diabesity with improvements cardiometabolic outcomes in the real-world settings as proven by previous RCTs and observational studies.
Research perspectives
Management of diabesity is often a clinical dilemma in the context of optimal glycemic control as several antidiabetic agents including insulins tend to cause weight gain with a potential for worsening of diabesity in a vicious cycle. SGLT-2i group of drugs improves glycemic control and cause weight loss when used in patients with diabesity. Moreover, SGLT-2i medications are useful in improving cardiometabolic outcomes and renal protection in patients with T2DM. We studied the comparative efficacy of dapagliflozin, empagliflozin and canagliflozin using a retrospective data from our hospital which revealed significant improvements in body weight, blood pressure, and glycated hemoglobin, with canagliflozin also showing improvement in albuminuria. They were also reasonably safe with acceptable side effect profile when used in the appropriate clinical context.
