SynthesisActa diabetologica2023

Dose-dependent renoprotection efficacy of sglt2 inhibitors in type 2 diabetes: systematic review and network meta-analysis.

Naveen C Hegde, Ankit Kumar, Amol N Patil, Samiksha Bhattacharjee, Nanda Gamad, Kripa Shanker Kasudhan, Vivek Kumar, Ashu Rastogi

Abstract readSystematic ReviewNetwork Meta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Acta diabetologica, 2023. The graph read 1 number from its abstract, feeding 1 cell of the map: it finds no clear difference in 1. Cited by 5 papers.

1number the graph read from it
1cell of the map it votes in
5citing papers in PubMed
1.6field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

← favours the treatmentfavours the comparator →
241 · no effect
Kidney outcomesno clear difference · against placebo · t2dfeeds one cell of the map
OR 2.300.72 to 3.90
Canagliflozin 100 mg demonstrated distinct eGFR benefit with an odds ratio of 2.3 (CI 0.72-3.9) compared to placebo.

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

SGLT2 inhibitors×kidney outcomes

InconclusiveOpen on the map →What to test next →

13 readable studies in this cell: 10 favour the treatment, 1 find no difference, 2 favour the comparator.

Belief with this paper
0.89established · 8 families support, 1 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the comparatorfavours the treatment →
1 · no effect
NCT02864914333,580 enrolled · 2016
IRR 0.690.45 to 1.05
NCT0546531762,197 enrolled · 2022
HR 0.750.65 to 0.86
NCT0173053417,190 enrolled · 2013
HR 0.760.67 to 0.87
NCT030579515,988 enrolled · 2017
Treatment by time interaction 1.360.86 to 1.86
NCT019897545,813 enrolled · 2014
HR 0.640.57 to 0.73
NCT020657914,401 enrolled · 2014
HR 0.700.59 to 0.82
NCT010326294,330 enrolled · 2009
OR 0.800.67 to 0.97
NCT030579773,730 enrolled · 2017
Treatment by time interaction 1.730.67 to 2.80

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

5 citing papers in PubMed, 8 citations in OpenAlex.

  1. Trial
  2. Review
  3. Article
  4. Article
  5. Article
6 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

7 · Who and what money

Authors and funding

8 authors at 1 institution in 1 country.

Naveen C Hegde *Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Ankit Kumar *Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Amol N PatilDepartment of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Samiksha BhattacharjeeDepartment of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Nanda GamadDepartment of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Kripa Shanker KasudhanDepartment of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Vivek KumarDepartment of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Ashu RastogiDepartment of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. ashuendo@gmail.com.ORCID http://orcid.org/0000-0002-9375-3102
Post Graduate Institute of Medical Education and Research · IN

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

aimTo compare the relative effects of different dosages of sodium-glucose cotransport inhibitors (SGLT2i) for renoprotection in Type 2 diabetes mellitus.

methodsThe study searched different databases (PubMed, Embase, Scopus, and Web of Science) for studies comparing dose-dependent renoprotective efficacy defined as a decline in eGFR with the different "-flozins namely Empagliflozin, Canagliflozin, Dapagliflozin, Ertugliflozin, Ipragliflozin, Luseogliflozin, Remogliflozin and Sotagliflozin. The studies were compared with the Bayesian approach of network meta-analysis coupled with the random-effect model using the Cochrane risk of bias tool (RoB 2.0), and the surface under the cumulative ranking curve (SUCRA) score was allotted to each dosage of different SGLT-2i.

resultsA total of 43,434 citations were identified, out of which forty-five randomized trials with 48,067 patients, mentioning the flozin dose and eGFR as an endpoint, were found to be eligible for further analysis. The median duration of the follow-up in the trials was 12 months (IQR 5.5-16 months). Canagliflozin 100 mg demonstrated distinct eGFR benefit with an odds ratio of 2.3 (CI 0.72-3.9) compared to placebo. A statistically non-significant eGFR benefit was observed with all other "-flozins." Canagliflozin 100 mg drug dose category showed the highest sucra rank probability score of 93%, followed by the Canagliflozin 300 mg and Dapagliflozin 5 mg with sucra rank probability scores of 69% and 65%, respectively. The Flozin-dose assessment against eGFR was similar to the albumin-creatinine ratios as the secondary endpoint in the SUCRA ranking.

conclusionThe renoprotective efficacy of SGLT2i is independent of the incremental doses suggesting lower doses may suffice for renal outcomes.

Indexed as

Diabetes Mellitus, Type 2Sodium-Glucose Transporter 2 InhibitorsBayes TheoremBenzhydryl CompoundsCanagliflozinGlucosidesHumansHypoglycemic AgentsBenzhydryl CompoundsCanagliflozindapagliflozinGlucosidesHypoglycemic AgentsSodium-Glucose Transporter 2 Inhibitors24-h urinary albuminAlbumin creatinine ratioCanagliflozinComposite renal outcomeDapagliflozineGFREmpagliflozinErtugliflozinIpragliflozin remogliflozinMAKESotagliflozin

Identifiers

PMID37322184
OpenAlexW4380785509

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.