title: Sodium-glucose cotransporter 2 inhibitors for type 2 diabetes: a systematic review and meta-analysis.
abstract: BACKGROUND
  Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new class of antidiabetic drugs.
  
  
  OBJECTIVE
  To assess the efficacy and safety of SGLT2 inhibitors in adults with type 2 diabetes.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane Library from inception through April 2013 without language restrictions; regulatory authorities' reports; and gray literature.
  
  
  METHODS
  Randomized trials comparing SGLT2 inhibitors with placebo or other medication for type 2 diabetes.
  
  
  METHODS
  Three reviewers extracted or checked data for study characteristics, outcomes of interest, and risk of bias, and 3 reviewers summarized strength of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.
  
  
  RESULTS
  Sodium-glucose cotransporter 2 inhibitors were compared with placebo in 45 studies (n = 11 232) and with active comparators in 13 studies (n = 5175). They had a favorable effect on hemoglobin A1c level (mean difference vs. placebo, -0.66% [95% CI, -0.73% to -0.58%]; mean difference vs. active comparators, -0.06% [CI, -0.18% to 0.05%]). Sensitivity analyses incorporating unpublished data showed similar effect estimates. Compared with other agents, SGLT2 inhibitors reduced body weight (mean difference, -1.80 kg [CI, -3.50 to -0.11 kg]) and systolic blood pressure (mean difference, -4.45 mm Hg [CI, -5.73 to -3.18 mm Hg]). Urinary and genital tract infections were more common with SGLT2 inhibitors (odds ratios, 1.42 [CI, 1.06 to 1.90] and 5.06 [CI, 3.44 to 7.45], respectively). Hypoglycemic risk was similar to that of other agents. Results for cardiovascular outcomes and death were inconclusive. An imbalance in incidence of bladder and breast cancer was noted with dapagliflozin compared with control.
  
  
  CONCLUSIONS
  Most trials were rated as high risk of bias because of missing data and last-observation-carried-forward methods.
  
  
  CONCLUSIONS
  Sodium-glucose cotransporter 2 inhibitors may improve short-term outcomes in adults with type 2 diabetes, but effects on long-term outcomes and safety are unclear.
  
  
  BACKGROUND
  None.
authors.forename: Despoina
authors.initials: D
authors.lastname: Vasilakou
authors.forename: Thomas
authors.initials: T
authors.lastname: Karagiannis
authors.forename: Eleni
authors.initials: E
authors.lastname: Athanasiadou
authors.forename: Maria
authors.initials: M
authors.lastname: Mainou
authors.forename: Aris
authors.initials: A
authors.lastname: Liakos
authors.forename: Eleni
authors.initials: E
authors.lastname: Bekiari
authors.forename: Maria
authors.initials: M
authors.lastname: Sarigianni
authors.forename: David R
authors.initials: DR
authors.lastname: Matthews
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tsapas
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018570:Risk Assessment; D015983:Selection Bias; D051297:Sodium-Glucose Transporter 2 / Q000009:adverse effects / Q000627:therapeutic use*; D015431:Weight Loss
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D051297:Sodium-Glucose Transporter 2