| Objective:Performing the meta analysis about effectiveness and safety of treatment of Sodium-glucose co-transporter 2 inhibitors on Diabetic NephropathyMethod:Use subject terms,keywords,any word in the computer system to Pubmed,Embase,the Cochrane library,Web of Science,Science and technology in Chinese journal full-text database,VIP database(VIP),the data resources of ten thousand system,service system of Chinese biomedical literature database to carry on the literature search,according to include and exclude criteria,select the inception database library to January 15,2021 published literature in both Chinese and English.Quality evaluation and data extraction were conducted for the literatures that met the requirements of this study.Meta-analysis of outcome indicators was performed using RevMan 5.5 software systemResults:A total of 28 Randomized controlled trials(RCTs)were included in this meta-analysis.Suggestions from traditional meta-analysis:SGLT-2 inhibitor treatment group was reduced Fasting blood glucose(FBG),Glycosylated Hemoglobin(Hb A1 c),Uric Acid(UA),24 hours urinary protein,serum creatinine(Scr),Body Mass Index.(BMI),Weight(W),Systolic Blood Pressure(SBP),Diastolic Blood Pressure(DBP),and High Density Lipoprotein(HDL-C)levels were higher than those in the control group.There was no statistical significance in reducing Urinary Albumin Creatinine Ratio(UACR),Low-Density Lipoprotein Cholesterol(LDL-C)and EGFR in the control group.In terms of adverse reactions,the experimental group was superior to the control group in terms of Severe adverse reaction events(SAE)and adverse events lead to discontinue events,but SGLT-2 inhibitor increases the risk of Genital Infection(GI),Diabetic Ketoacidosis(DKA),and Adverse reactions related to insufficient volume.There was no statistical significance in overall Adverse Events(AE),Hypoglycemic Events,Renal Adverse Outcome Events(RAGE),Urinary tract infection(UTI),and Fracture between the control group and the experimental group.The results of network meta-analysis indicated that compared with other treatment regimens,Canagliflozin had a better effect on reducing SBP and a lower incidence of total adverse events(SUCRA:69.6%and 86.7%,respectively)according to the surface under the cumulative ranking(SUCRA).Dapagliflozin net reduced HbAlc,weight effect was better,and the incidence of adverse event discontinued was lower,with SUCRA of 72.7%,86.5%,94.7%,respectively.The net effect of Empagliflozin on reducing SBP,Scr and UA was better,and its SUCRA was 70.7%,64.8%and 69.0%,respectively.The incidence of hypoglycemia and urinary tract infection after treatment with Empagliflozin was lower,and the SUCRA was 66.1%and 94.6%,respectively.The rate of volume-related adverse reactions and genital infection was significantly lower after PBO treatment,with SUCRA of 80.5%and 92.8%,respectively.Conclusion:Traditional meta-analysis suggest:SGLT-2 inhibitors can reduce fasting blood glucose,HbAlc,SBP,DBP,body weight,BMI and SCR in DN patients to a certain extent,produce positive effects on treatment of DN patients,does not increase the risk of hypoglycemia,urinary tract infection,fractures.However,there may be greater risks in genital infection,volume insufficient-related and DKA adverse events,and the overall efficacy and safety are acceptable.Network-Meta analysis suggest:Dapagliflozin was more effective in reducing HbAlc,body weight,Empagliflozin had better effect on reducing SBP,SCR and UA,the incidence of hypoglycemia and urinary tract infection were lower after treatment with Ertugliflozin,the net effect of Canagliflozin in reducing SBP was better and the incidence of total adverse events was lower. |
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