جستجوی مقالات مرتبط با کلیدواژه « dapagliflozin » در نشریات گروه « پزشکی »

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a new diabetes treatment. Considering the prescription of these medicines for kidney transplant patients, this systematic review and meta-analysis aimed to investigate the impact of SGLT2 inhibitors on kidney transplant patients.

This meta-analysis study was performed based on the PRISMA guideline. The necessary data were collected by searching the databases of Scopus, PubMed, Cochrane, Google Scholar search engine, and Web of Science without a time limit until March 1, 2023. The data were analyzed in STATA 14. A P value less than 0.05 was considered significant.

The authors assessed eight articles with a sample size of 960 patients. The SGLT2 inhibitors showed no significant impact on levels of estimated glomerular filtration rate [SMD: -0.21 (95% CI: -0.65, 0.25)], serum creatinine [SMD: -0.02 (95% CI: -0.19, 0.15)], plasma hemoglobin A1c (HbA1c) [SMD: -0.62 (95% CI: -1.43, 0.18)], systolic blood pressure [SMD: -0.64 (95% CI: -1.80, 0.52)], and diastolic blood pressure [SMD: -0.64 (95% CI: -1.41, 0.14)], and on the patient’s weight [SMD:-0.31 (95% CI: -0.80, 0.18)]. Patient age did not influence the impact of SGLT2 inhibitors on estimated glomerular filtration rate (50–59 years-old age group: [SMD: 0.13 (95% CI: -0.04, 0.30)], 60–69 years-old age group: [SMD: -0.56 (95 % CI: -1.38, 0.26]). Duration of medicine use did not affect the impact of SGLT2 inhibitors on estimated glomerular filtration rate [6 months after medicine use: SMD: -0.56 (95% CI: -1.38, 0.26)], 12 months after medicine use: [SMD: 0.10 (95% CI: -0.05, 0.26)].

SGLT2 inhibitors were not effective in lowering blood pressure, estimated glomerular filtration rate, serum creatinine, and hemoglobin A1c levels, or weight in kidney transplant patients. Although SGLT2 inhibitors were ineffective in improving kidney transplant patients’ renal function, there were no side effects, and the administration of this drug in kidney transplant patients can continue. Further research is required to ensure safety and determine the appropriate dosage and duration of drug use.

Registration: 

The study was compiled according to the PRISMA checklist and its protocol was registered on the PROSPERO (ID: CRD42023407501) and Research Registry (UIN: reviewregistry1666) websites.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are the most recent pharmaceutical group for type 2 diabetes (T2D) treatment. Evidence indicates contradictory relationships between sodium-glucose cotransporter-2 inhibitors and bladder cancer (BC). Hence, this study aims to investigate the relationship between SGLT2 inhibitors and BC in patients with T2D.

This study is a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). International databases including Cochrane, Web of Science, Scopus, PubMed, and Google Scholar were conducted for searching with keywords and without time and language limitations. The reference searching stage continued upgrading until November, 2022. Data analysis was performed with STATA 14 software. The tests with P values lower than 0.05 were considered statistically significant.

The four reviewed studies with a sample size comprising 497 755 individuals indicated the impact of SGLT2 inhibitors on BC of patients with T2D (OR: 0.68; 95% CI: 0.37, 1.2). The effect of dapagliflozin, canagliflozin and empagliflozin administration on the incidence of BC among the T2D patients were (OR: 0.72; 95% CI: 0.39, 1.30), (OR: 0.53; 95% CI: 0.23, 1.20), and (OR: 0.51; 95% CI: 0.20, 1.28), respectively.

The general conclusion of this study revealed that SGLT2 inhibitors did not increase the risk of BC in T2D patients. The analysis of subgroups also indicated that the administration of dapagliflozin, canagliflozin, and empagliflozin also did not increase the risk of BC in T2D patients.

Subcutaneous insulin resistance syndrome (SIRS) is a rare condition in which patients poorly respond to subcutaneous (SC) insulin but maintain a normal response to intravenous (IV) insulin. The underlying pathophysiology remains elusive. Several treatment regimens have been tested for the management of SIRS, none of which included a sodium-glucose cotransporter-2 inhibitor (SGLT-2).

Two cases of type 1 diabetes initially achieved adequate glycemic control with subcutaneous insulin. Both cases later progressed into recurrent diabetic ketoacidosis that would resolve following IV insulin administration. Further investigation revealed unresponsiveness to SC insulin, but not IV, and the clinical diagnosis of SIRS was established accordingly. HbA1c values for cases 1 and 2 were 11% on 400 units/day of SC insulin, and 12% on 350 - 400 units/day of SC insulin, respectively. The patients required very high doses of intramuscular (IM) insulin. Subsequently, dapagliflozin as adjunct therapy significantly reduced the patients’ IM insulin requirements beyond the anticipated dose reduction. Ultimately, case 1 achieved an HbA1c of 7 - 8% on 90 units/day of IM insulin and 10 mg/day of dapagliflozin, and case 2 achieved an HbA1c of 7 - 8% on 120 units/day of IM insulin and 10 mg/day of dapagliflozin.

These are the first reported cases of SIRS in which dapagliflozin, an SGLT-2 inhibitor, was used. The substantial reduction in the IM insulin dose following the addition of dapagliflozin in our reported cases of SIRS suggests a possible novel mechanism for dapagliflozin beyond its glucosuric effects. In this report, we present a hypothetical basis for this possible novel mechanism.

To investigate the effect of dapagliflozin combined with cognitive behavior training on quality of life and cognitive function in elderly patients with type 2 diabetes mellitus (T2DM) complicated with mild cognitive impairment.

Ninety-six elderly patients with T2DM and mild cognitive impairment treated in Shenzhen People’s Hospital, Guangdong Province China from June 2019 to December 2020 were selected and equally randomized into control group (CG) and experimental group (EG). The CG received conventional intervention, while the EG received dapagliflozin combined with cognitive behavior training based on the CG. The clinical observation indexes of both groups were compared to assess the clinical intervention effect of dapagliflozin combined with cognitive behavior training on elderly patients with T2DM complicated with mild cognitive impairment.

After intervention, the blood glucose levels of both groups decreased, and compared with the CG, the blood glucose level of the EG was markedly lower (P<0.05). The scores of C-DMSES, ADL and MMSE of both groups were higher than those before intervention, and compared with the CG, the scores of the EG were obviously higher (P<0.05). The QOL-AD scores of both groups gradually increased, and compared with the CG, the QOL-AD scores of the EG were higher at 3 and 6 months after intervention (P<0.05).

For elderly patients with T2DM complicated with mild cognitive impairment, dapagliflozin combined with cognitive behavior training intervention can obviously improve their cognitive function, self-efficacy of diabetes management and quality of life, which should be promoted in clinic.

The dapagliflozin’s safety profile in insulin-treated adult type-1 diabetes mellites (T1DM) patients remains poorly explored. Therefore, this systematic review and meta-analysis compared the risk of all-cause side effects, study discontinuation of participants due to side effects, urinary tract infection (UTI), diabetic ketoacidosis, and hypoglycemia between dapagliflozin 10 mg and dapagliflozin 5 mg, dapagliflozin 10 mg and placebo, and dapagliflozin 5 mg and placebo.

Parallel-arm randomized controlled trials juxtaposing the above outcomes between the afore-mentioned interventions were eligible for inclusion in this study and were searched in PubMed, Embase, and Scopus. Utilizing the Cochrane tool, the risk of bias was assessed in the recruited trials. Finally, by random-effect meta-analysis, each outcome was compared among the above interventions, and the risk ratio was estimated.

Four trials of varying length (1-52 weeks) sourcing data from almost 1760 participants from about 32 nations were reviewed. Overall, the trials had a low or unclear risk of bias, and only one was at a high risk of bias.  Compared to the placebo, the risk of side effects was higher in those treated with dapagliflozin 5 mg (RR=1.10; 95% CI=1.02-1.18; p=0.014; I2=0%). UTI risk was less with the 10mg dapagliflozin than its lower dose (RR=0.50; 95% CI=0.32-0.79; p-value=0.003; I2=0%). All the remaining comparisons were statistically not significantly different between the juxtaposed intervention pairs.

In contrast to placebo, dapagliflozin 5mg increased the risk of overall adversities in insulin-treated type-1 diabetes, and dapagliflozin 10 mg had a reduced risk of UTI than its 5mg preparation.