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The effect of sodium-glucose cotransporter 2 inhibitors on biomarkers of inflammation: A systematic review and meta-analysis of randomized controlled trials

Affiliation
Department of Endocrinology ,NHC Key Laboratory of Endocrinology ,Peking Union Medical College Hospital ,Peking Union Medical College and Chinese Academy of Medical Sciences ,Beijing ,China
Wang, Dongmei;
Affiliation
Department of Endocrinology ,NHC Key Laboratory of Endocrinology ,Peking Union Medical College Hospital ,Peking Union Medical College and Chinese Academy of Medical Sciences ,Beijing ,China
Liu, Jieying;
Affiliation
Department of Endocrinology ,NHC Key Laboratory of Endocrinology ,Peking Union Medical College Hospital ,Peking Union Medical College and Chinese Academy of Medical Sciences ,Beijing ,China
Zhong, Ling;
Affiliation
Department of Endocrinology ,NHC Key Laboratory of Endocrinology ,Peking Union Medical College Hospital ,Peking Union Medical College and Chinese Academy of Medical Sciences ,Beijing ,China
Li, Shunhua;
Affiliation
Department of Endocrinology ,NHC Key Laboratory of Endocrinology ,Peking Union Medical College Hospital ,Peking Union Medical College and Chinese Academy of Medical Sciences ,Beijing ,China
Zhou, Liyuan;
Affiliation
Department of Endocrinology ,NHC Key Laboratory of Endocrinology ,Peking Union Medical College Hospital ,Peking Union Medical College and Chinese Academy of Medical Sciences ,Beijing ,China
Zhang, Qian;
Affiliation
Department of Endocrinology ,NHC Key Laboratory of Endocrinology ,Peking Union Medical College Hospital ,Peking Union Medical College and Chinese Academy of Medical Sciences ,Beijing ,China
Li, Ming;
Affiliation
Department of Endocrinology ,NHC Key Laboratory of Endocrinology ,Peking Union Medical College Hospital ,Peking Union Medical College and Chinese Academy of Medical Sciences ,Beijing ,China
Xiao, Xinhua

Aims: Inflammatory biomarkers may play vital roles in the pathophysiology of diabetes and diabetic cardiorenal complications. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have a potential cardiovascular and renal protective effect in type 2 diabetes. The aim of this meta-analysis was to quantify the effects of SGLT2 inhibitors on biomarkers of inflammation in randomized controlled trials (RCTs). Methods: PubMed, Cochrane Library, EMBASE, and Web of Science were searched for eligible RCTs of adults with type 2 diabetes (T2D) with no time limit (updated to 12 October 2022). The biomarkers selected included C-reactive protein (CRP), interleukin-6, tumor necrosis factor-alpha, leptin, adiponectin, ferritin, plasminogen activator inhibitor (PAI)-1, and vascular cell adhesion molecule-1. Data were analyzed using a random-effect model in Review Manager 5.4. Results: Thirty-four studies with 6,261 patients (68.6% male) were eligible for this meta-analysis. The mean age of the participants was 62.57(±11.13) years old, and the median treatment duration length with follow-up was 24 weeks. Generally, the included trials were of good methodological quality. The meta-analysis revealed that ferritin levels were significantly reduced in SGLT2 inhibitor treatment groups versus placebo or standard diabetes therapies (SMD: −1.21; 95% CI: −1.91, −0.52, p < 0.001). The effects of CRP (SMD: 0.25; 95% CI: −0.47, −0.03, p = 0.02) and leptin (SMD: −0.22; 95% CI: −0.43, −0.01, p = 0.04) were reduced, and the effects of adiponectin were improved (SMD: 0.28; 95% CI: 0.15, 0.41, p < 0.001) in placebo-controlled studies. PAI-1 levels were significantly reduced in studies controlled for diabetes therapies (SMD: −0.38; 95% CI: −0.61, −0.15, p = 0.001). Conclusion: This analysis provides strong evidence supporting anti-inflammatory effects of SGLT2 inhibitors in T2D subjects. The mechanisms and possible targets for the inflammation reducing and cardiorenal protective properties of SGLT2 inhibitors remain to be explored.

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License Holder: Copyright © 2022 Wang, Liu, Zhong, Li, Zhou, Zhang, Li and Xiao.

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