ACEI/ARB, SGLT2 inhibitors combo better for diabetes control than ACEI/ARB alone: Study
China: The combo of SGLT2 inhibitors and ACEI/ARB is effective and well-tolerated than ACEI/ARB alone in patients with type 2 diabetes (T2D), reveals a recent study in the journal Nephrology Dialysis Transplantation. According to the study, the combo achieved additional effects including decrease in blood sugar and body weight, better control of blood pressure, alleviation of long-term renal function, and improvement of renal outcomes. However, the combination therapy showed an increased hypoglycemia risk.
Min Han, Huazhong University of Science and Technology, Wuhan, China, and colleagues aimed to to evaluate the efficiency and safety of combination therapy with SGLT2 inhibitors and RAS blockers, such as ACEI/ARB, in patients with T2D.
For the purpose, the researcher searched the online databases from their inception to May 2020. Study selection, risk of bias assessment and data extraction was independently performed by two authors.
A total of 7 studies consisting of 1757 patients were included.
Key findings of the study include:
- Compared with ACEI/ARB alone, combination therapy with SGLT2 inhibitors and ACEI/ARB produced reduction in SBP (WMD -3.84 mmHg), DBP (WMD -1.06 mmHg), 24 h ambulatory SBP (WMD -4.59 mmHg), 24 h ambulatory DBP (WMD -2.08 mmHg), UACR(WMD -29.70%), eGFR (WMD -3.46 mL/min per 1·73 m2), HbA1c (SMD -0.48), FPG (SMD -0.28), uric acid (SMD -0.35), and body weight (SMD -0.29).
- The risk of hypoglycemia with combination therapy was higher than the control group (RR 1.37).
- As for the risk of total AEs, genital infection and urinary tract infection, no significant difference was revealed.
"Compared with ACEI/ARB alone, the combination therapy with SGLT2 inhibitors and ACEI/ARB in T2DM was effective and well-tolerated, and could achieve additional effects, including better control of blood pressure, improvement of renal outcomes, alleviation of long-term renal function, and decrease of blood glucose and body weight," wrote the authors. "The combination therapy showed an increased risk of hypoglycemia."
The study titled, "Efficacy and safety of Combination Therapy with Sodium-glucose Transporter 2 Inhibitors and Renin-Angiotensin System Blockers in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis," is published in the journal Nephrology Dialysis Transplantation.
DOI: https://academic.oup.com/ndt/advance-article-abstract/doi/10.1093/ndt/gfab048/6144902
