21 kinds of hypoglycemic drugs-blood pressure, weight loss "super power" ranking!

Yimaitong compiles and organizes, please do not reprint without authorization
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Obesity and hypertension are common comorbidities of type 2 diabetes
.

When prescribing hypoglycemic drugs, it is the basic operation of endocrinologists to consider "the effect of drugs on body weight and blood pressure"
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However, there may only be a rough impression of certain types of drugs in our minds.
For example, metformin, SGLT-2i, GLP-1RA can reduce weight, and insulin can increase weight.
.
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Then, the effects of different types of drugs on body weight and blood pressure How big is the difference? This "Da Hengping"-like study, which included 21 hypoglycemic drugs, brought more specific digital comparison results
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 424 RCTs, designed to assess the effects of 21 hypoglycemic drugs on weight/blood pressure.
In this systematic review and network meta-analysis involving 424 RCT trials involving more than 270,000 participants, scientific researchers have included (insulin, The weight loss and blood pressure effects of 21 antidiabetic drugs in 9 categories, including metformin, SGLT-2i, GLP-1RA, DPP-4i, thiazolidinedione, and Glinide, etc.
, have been comprehensively evaluated
.

In order to balance the differences in drug dosage, population characteristics, medication time and other aspects between different studies, the researchers adopted data analysis methods to pull the drugs as far as possible to the "same starting line" for comparison
.

The research results were recently published in the journal Diabetes obesity & metabolism (IF: 5.
9)
.

 The effect of hypoglycemic drugs on body weight-SGLT-2i and GLP-1RA have outstanding "scores", and metformin is unexpected.
1.
The study of hypoglycemic drugs that can effectively reduce weight found that compared with placebo: ➤Smeglutide (subcutaneous Injection) has the best "efficacy" in weight loss.
Compared with placebo, it can reduce body weight by 3.
14-4.
46kg; ➤Secondly, simeglutide (oral), exenatide (2 times a day) and Liraglutide can reduce body weight by 2.
37-2.
41kg; ➤Followed by enpagliflozin, canagliflozin, dapagliflozin and etogliflozin in SGLT-2i, which can reduce weight by 1.
80-1.
92 kg; ➤Lixisenatide (lixisenatide), exenatide weekly preparation and dulaglutide are weaker in weight loss, and can reduce weight by 0.
80-1.
04kg; ➤Some surprises are that metformin is losing weight.
The "curative effect" in the major aspects does not seem to be very obvious, with a weight loss of 0.
62kg
.

 A direct comparison between similar drugs found that: ➤GLP-1RA: semaglutide, exenatide (2 times/day), and liraglutide have better weight loss effects than exenatide weekly preparations and lixisenatide That peptide (lixisenatide) and dulaglutide; ➤SGLT-2i: No significant difference was found between similar drugs
.

See Table 1 for detailed data
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Table 1 The effect of hypoglycemic drugs on weight (compared to placebo) 2.
Antidiabetic drugs that may increase weight In addition to the above drugs, other drugs may increase weight: ➤The weight gain of pioglitazone drugs is the most obvious, with an average increase 2.
97kg; ➤In addition, the weight gain caused by insulin, sulfonylureas and Glinide drugs is also more obvious, with an average increase of 1.
72kg to 2.
91kg
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 Note: The color represents the level of evidence, green=high, blue=medium, orange=low
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Figure 1 Network meta-analysis: the effect of hypoglycemic drugs on body weight (kg, compared with placebo) The study on the effect of hypoglycemic drugs on blood pressure (systolic blood pressure) found that compared with placebo: ➤ In terms of "efficacy" in reducing systolic blood pressure SGLT-2i and GLP-1RAs have the most obvious effects.
The former reduces an average of 2.
89mmHg, and the latter reduces an average of 2.
33mmHg; ➤In SGLT-2i, canagliflozin has the best blood pressure reduction effect (reducing systolic blood pressure by 3.
38mmHg) , Followed by enpagliflozin (reduction of 3.
29mmHg), oral smeglutide (reduction of 3.
06mmHg); ➤simeglutide (subcutaneous administration), exenatide (2 times/day), eto Gligliflozin, liraglutide, and dapagliflozin can reduce blood pressure by 2.
93~2.
34mmHg; ➤Exenatide weekly preparation and dulaglutide can reduce systolic blood pressure by 1.
76 and 1.
34mmHg, respectively, and metformin by 1.
07mmHg, DPP -4i reduces 0.
73mmHg; ➤Other drugs have no obvious effect on systolic blood pressure
.

 A direct comparison between similar drugs found that smeglutide has a better "hypertensive effect" than dulaglutide and lixisenatide.
It is one of the other GLP-1RA and SGLT-2i drugs in the group.
There is no obvious difference between them
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 See Table 2 for detailed data
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Table 2 Effect of hypoglycemic drugs on systolic blood pressure (compared to placebo) Figure 2 Network meta-analysis: Effect of hypoglycemic drugs on systolic blood pressure (mmHg, compared to placebo) In summary, in terms of reducing systolic blood pressure, SGLT-2i and GLP- The effect of 1RA is also more obvious
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 The study on the effect of hypoglycemic drugs on blood pressure (diastolic blood pressure) found that, compared with placebo: ➤Engligliflozin has the best "efficacy" in reducing diastolic blood pressure, with an average reduction of 1.
68mmHg; ➤Dapagliflozin, Kagata Liegliflozin, exenatide (2 times/day), and pioglitazone can also bring about a significant decrease in diastolic blood pressure (reducing 1.
02-1.
45mmHg), while the effects of etogliflozin and smeglutide are relatively weak; ➤ The therapeutic effects of other hypoglycemic drugs are mostly neutral
.

 A direct comparison between similar drugs found that: ➤GLP-1RA: Exenatide (2 times/day), smeglutide is better than dulaglutide; ➤SGLT-2i: Englitazone is better than Elto Glydeine
.

See Table 3 for detailed data
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  Table 3 Effect of hypoglycemic drugs on diastolic blood pressure (compared to placebo) Figure 3 Network meta-analysis: Effect of hypoglycemic drugs on diastolic blood pressure (mmHg, compared to placebo) Summary There is medium and high-level evidence that GLP-1RAs—— Simeglutide (subcutaneous administration), simeglutide (oral), exenatide (2 times a day) and liraglutide have the best "efficacy" in weight loss, followed by four SGLT-2i-Enpagliflozin, canagliflozin, dapagliflozin, and atogliflozin
.

At the same time, these eight drugs are also related to the reduction of systolic blood pressure: canagliflozin, empagliflozin and simegliutide (orally) have the largest decrease, followed by simegliutide (subcutaneous injection) and AIDS.
Sernatide (2 times/day), etogliflozin, liraglutide and dapagliflozin
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Exenatide weekly preparation and dulaglutide brought a moderate reduction in body weight and systolic blood pressure
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Four kinds of SGLT-2i, as well as GLP-1 RAs Exenatide (2 times/day), Smeglutide (subcutaneous administration/oral administration), can also reduce diastolic blood pressure
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In summary, the study found that GLP-1RA and SGLT-2i are the most effective classes of drugs for reducing body weight and blood pressure in patients with type 2 diabetes
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In addition, there is evidence that the related benefits of smeglitaide, empagliflozin, canagliflozin, dapagliflozin and etogliflozin can last for more than one year, while metformin is reducing weight , The role of blood pressure reduction seems to be small
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Researchers believe that for patients with type 2 diabetes who are overweight, obesity, and hypertension, these drugs can bring additional benefits in terms of weight loss and blood pressure
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Yimaitong compiled and compiled from: Tsapas A, Karagiannis T, Kakotrichi P, et al.
Comparative efficacy of glucose-lowering medications on body weight and blood pressure in patients with type 2 diabetes: a systematic review and network meta-analysis[J] .
Diabetes, obesity & metabolism.
2021 May 28.
DOI: 10.
1111/dom.
14451.