| ObjectiveDiabetes is the most common cause of end-stage renal disease worldwide.With the increasing prevalence of diabetes,the incidence of diabetes nephropathy is also increasing.The current new hypoglycemic drugs,including sodium glucose transporter 2(SGLT-2)inhibitor,glucagon like peptide 1 receptor(GLP-1R)agonist,dipeptidyl peptidase IV(DPP-4)inhibitor,and metformin(Met),a traditional hypoglycemic drug,can reduce the blood sugar of patients with type 2 diabetes,It may also exert renal protective effects through mechanisms such as inhibiting oxidative stress,inflammation,improving glucose and lipid metabolism,reducing proteinuria,and improving metabolic related risk factors.Due to the lack of direct head to head research on these four drugs,it is also impossible to directly determine the advantages and disadvantages of these four drugs in improving the renal protection efficacy of patients with type 2 diabetes.In this paper,the effectiveness of the above four drugs for renal protection in diabetes patients was indirectly compared through mesh Meta analysis to provide a reference for clinicians to reasonably select hypoglycemic drugs.MethodsA comprehensive search was conducted on Pub Med,Embase,Cochrane Library,and Web of Science databases from their establishment until December 31,2022.According to preset inclusion and exclusion criteria,a randomized controlled trial(RCT)was conducted to compare SGLT-2 inhibitors,GLP-1R agonists,DPP-4inhibitors,and metformin with other hypoglycemic drugs,placebos,or blank control groups related to renal outcomes in T2 DM patients.The final quality evaluation of the study was independently conducted by two researchers using the Cochrane Bias Risk Assessment Tool,and the results were provided by Revman 5.4 software.The outcome indicators were all continuous variables,represented by mean difference(MD),standard deviation(SD),and 95% confidence intervals(CI).ResultsThis study ultimately included 17 RCT articles,totaling 10065 patients.According to the results of the mesh meta-analysis,it is suggested that:1.A total of 15 RCT articles provided data related to the outcome indicator e GFR,including 4intervention measures,with a total of 10890 patients,including 5540 in the experimental group and 5350 in the control group.The results showed that in terms of the outcome index e GFR,metformin could significantly improve the e GFR level of type 2 diabetes patients compared with placebo or standardized treatment(MD=3.40,95% CI: 1.00,5.80),with a statistically significant difference.2.A total of 8 RCT articles provide data related to the outcome indicator serum creatinine(Scr),including3 intervention measures,with a total of 1080 patients,including 545 in the experimental group and 535 in the control group.The results suggest that SGLT-2inhibitor(MD=-0.02,95% CI:-0.04,0.00)and DPP-4 inhibitor(MD=-0.03,95% CI:-0.06,0.00)can reduce Scr in type 2 diabetes patients compared with "placebo or standardized treatment",and the difference is statistically significant.3.A total of 5RCT articles provide data related to the outcome indicator urea nitrogen(BUN),including 3 intervention measures,with a total of 739 patients,including 375 in the experimental group and 364 in the control group.The results suggest that metformin(MD=-1.79,95% CI:-3.29,-0.28)can significantly reduce BUN compared to SGLT-2inhibitors,with a statistically significant difference.4.A total of 6 RCT articles provide data related to the outcome indicator uric acid,including 3 interventions,with a total of 703 patients,including 354 in the experimental group and 349 in the control group.The results showed that SGLT-2i(MD=-0.41,95% CI:-0.77,-0.05)significantly improved patients’ uric acid compared to "placebo or standardized treatment",with a statistically significant difference.ConclusionFour antidiabetic drugs were compared by network meta-analysis,and metformin was the best in protecting e GFR in patients with type 2 diabetes;SGLT-2inhibitors are more effective in reducing uric acid in patients;DPP-4 inhibition can significantly reduce the creatinine level in type 2 diabetes patients. |
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