Effects of sodium-glucose cotransporter-2 inhibitors use in asia towards cardiorenal outcomes: Updated systematic review and meta-analysis

Effective diabetes prevention and control are needed to address Asia’s growing diabetes epidemic. This meta-analysis assessed how sodium-glucose cotransporter-2 inhibitors (SGLT2Is) affected cardiorenal outcomes in Asians. A comprehensive review of literature from PubMed, EMBASE, CENTRAL, and citation searching up to December 2023 identified 13 randomized controlled trials comparing SGLT2Is and placebo, involving 14, 922 Asians with type 2 diabetes and a history of atherosclerotic cardiovascular disease risk, heart failure (HF), or chronic kidney disease. The RoB 2 tool assessed bias, while RevMan 5.3 synthesized quantitative data. There was no significant reduction in major adverse cardiovascular events for Asians (HR = 0.82, 95%CI = 0.66–1.01) or in the Asia region (HR = 0.88, 95%CI = 0.76–1.01). However, a notable benefit was observed for the composite of cardiovascular death/worsening HF in Asians (HR = 0.64, 95% CI = 0.52–0.80) and the Asia region (HR = 0.66, 95%CI = 0.58–0.75). Additionally, SGLT2Is demonstrated favorable renal outcomes for Asians (HR = 0.64, 95% CI = 0.51–0.80) and the Asia region (HR = 0.64, 95%CI = 0.56–0.74). Safety assessments revealed 2.88 times increased risk of Genital Mycotic Infections. GRADE analysis showed moderate to high certainty for all primary outcomes. In conclusion, SGLT2Is improve Asian renal outcomes. Real-world studies in Asia are recommended to assess the practical cardiorenal efficacy of SGLT2Is in routine healthcare settings.