Evidence mapPaperPMID 40511485Full record

ArticleDiabetes, obesity & metabolism2025

The effect of sodium-glucose cotransporter 2 inhibitors on HbA1c variability and cardiovascular and renal adverse outcome in patients with T2DM.

Ran Guo, Ambarish Pandey, Chanchal Chandramouli, Mei-Zhen Wu, An-Ping Cai, Ying-Xian Liu, Qing-Wen Ren, Jia-Yi Huang, Jing-Nan Zhang, Wen-Li Gu and 9 more

Abstract read
In one paragraph

Article in Diabetes, obesity & metabolism, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
field-weighted citation impact
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.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · 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.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

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

5 · Who and what money

Authors and funding

19 authors.

Ran GuoDivision of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.ORCID https://orcid.org/0000-0003-0654-6314
Ambarish PandeyDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Chanchal ChandramouliNational Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore.
Mei-Zhen WuDivision of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
An-Ping CaiDepartment of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.ORCID https://orcid.org/0000-0002-5587-5811
Ying-Xian LiuDepartment of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Qing-Wen RenDivision of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Jia-Yi HuangDivision of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Jing-Nan ZhangDivision of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Wen-Li GuDivision of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Hao-Chen XuanDivision of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Wouter OuwerkerkNational Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore.
Jasper TrompDuke-National University of Singapore Medical School, Singapore, Singapore.
Tiew-Hwa Katherine TengNational Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore.
Christopher Tze-Wei TsangDivision of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.ORCID https://orcid.org/0000-0003-3394-6604
Ching-Yan ZhuDivision of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Yik-Ming HungDivision of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Carolyn S P LamNational Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore.ORCID https://orcid.org/0000-0003-1903-0018
Kai-Hang YiuDivision of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.ORCID https://orcid.org/0000-0003-2145-3108

Funding

HKU-SZH Fund for Shenzhen Key Medical Discipline SZXK2020081National Natural Science Foundation of China 82270400Natural Science Foundation of Guangdong Province 2023A1515010731Sanming Project of Medicine in Shenzen Municipality SZSM202411021
6 · The paper itself

Abstract

aimsTo compare the effectiveness of sodium-glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase 4 (DPP-4) inhibitors in reducing haemoglobin A1c (HbA1c) variability and improving cardiovascular and renal outcomes in patients with type 2 diabetes mellitus (T2DM) and high HbA1c variability.

methodsThis territory-wide cohort study involved patients with T2DM and an HbA1c variability score (HVS) >60% who initiated SGLT2 inhibitors or DPP-4 inhibitors in Hong Kong between 2015 and 2022. Propensity score (PS) matching was used to adjust for confounders. The primary outcome was post-treatment HVS within 3 years. Secondary outcomes included major adverse cardiovascular events (MACE) and serious renal events (SRE).

resultsAmong 20,205 T2DM patients with a baseline HVS >60%, 4,612 SGLT2 inhibitor users were 1:1 matched with DPP-4 inhibitor users. When referencing the 0%-20% quintile, patients initiating SGLT2 inhibitors versus DPP-4 inhibitors exhibited a reduced likelihood of being in higher HVS quintiles [21%-40%: odds ratio (OR) 0.76, 95% confidence interval (CI) 0.66-0.88; 41%-60%: OR 0.57, 95% CI 0.50-0.65; 61%-80%: OR 0.49, 95% CI 0.42-0.56; and 81%-100%: OR 0.40, 95% CI 0.34-0.47]. SGLT2 inhibitors were associated with a reduced risk of MACE [hazard ratio (HR) 0.69; 95% CI 0.60-0.79] and SRE (HR 0.71; 95% CI 0.63-0.80) compared to DPP-4 inhibitors.

conclusionIn patients with high HbA1c variability, SGLT2 inhibitor initiation was associated with superior effectiveness in reducing HbA1c variability compared to DPP-4 inhibitors. The initiation of SGLT2 inhibitors versus DPP-4 inhibitors was linked to significantly reduced cardiovascular and renal adverse events.

Indexed as

Cardiovascular DiseasesDiabetes Mellitus, Type 2Diabetic NephropathiesDipeptidyl-Peptidase IV InhibitorsGlycated HemoglobinSodium-Glucose Transporter 2 InhibitorsAgedCohort StudiesFemaleHong KongHumansMaleMiddle AgedTreatment OutcomeDipeptidyl-Peptidase IV InhibitorsGlycated Hemoglobinhemoglobin A1c protein, humanSodium-Glucose Transporter 2 Inhibitorscardiovascular and renal protectionDPP‐4 inhibitorsHbA1c variabilitySGLT2 inhibitorstype 2 diabetes mellitus

Identifiers

PMID40511485
PMCPMC12326940

What Socratic holds

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Registered trials

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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.