AI Article Synopsis
- A systematic review was conducted to explore the relationship between clinical and biological features and the effectiveness of two diabetes treatments: SGLT2-inhibitors and GLP1-receptor agonists, focusing on outcomes like glycaemic control, cardiovascular health, and kidney function.
- Out of over 5,600 studies screened, only 101 for SGLT2-inhibitors and 75 for GLP1-receptor agonists were included, but many had methodological flaws that limited their reliability in assessing how different patients react to these treatments.
- Findings suggest that factors like lower kidney function and reduced insulin secretion could affect treatment responses, but overall evidence is weak; further well-designed studies are needed to better understand treatment diversity and enhance
Article Abstract
Background: A precision medicine approach in type 2 diabetes requires the identification of clinical and biological features that are reproducibly associated with differences in clinical outcomes with specific anti-hyperglycaemic therapies. Robust evidence of such treatment effect heterogeneity could support more individualized clinical decisions on optimal type 2 diabetes therapy.
Methods: We performed a pre-registered systematic review of meta-analysis studies, randomized control trials, and observational studies evaluating clinical and biological features associated with heterogenous treatment effects for SGLT2-inhibitor and GLP1-receptor agonist therapies, considering glycaemic, cardiovascular, and renal outcomes. After screening 5,686 studies, we included 101 studies of SGLT2-inhibitors and 75 studies of GLP1-receptor agonists in the final systematic review.
Results: Here we show that the majority of included papers have methodological limitations precluding robust assessment of treatment effect heterogeneity. For SGLT2-inhibitors, multiple observational studies suggest lower renal function as a predictor of lesser glycaemic response, while markers of reduced insulin secretion predict lesser glycaemic response with GLP1-receptor agonists. For both therapies, multiple post-hoc analyses of randomized control trials (including trial meta-analysis) identify minimal clinically relevant treatment effect heterogeneity for cardiovascular and renal outcomes.
Conclusions: Current evidence on treatment effect heterogeneity for SGLT2-inhibitor and GLP1-receptor agonist therapies is limited, likely reflecting the methodological limitations of published studies. Robust and appropriately powered studies are required to understand type 2 diabetes treatment effect heterogeneity and evaluate the potential for precision medicine to inform future clinical care.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10551026 | PMC |
| http://dx.doi.org/10.1038/s43856-023-00359-w | DOI Listing |
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