| Background:Arterial stiffness,also known as arteriosclerosis,is a non-inflammatory disease of the arteries.It is a vascular disease that occurs with age.It is inextricably linked to various diseases and can also predict cardiovascular events and all-cause mortality.Diabetes patients have a higher incidence of cardiovascular events and mortality,the mechanism of which is not completely clear.Studies have found that arterial stiffness may be one of the important ways to increase the risk of cardiovascular disease and also the independent predictors mortality in diabetes.At present,the treatment of arterial stiffness is mainly antihypertensive drug and statins,but the effect is limited.Strategies related to arterial stiffness of diabetic patients such as diet control,aerobic exercise,and drugs for AGE cross-linking are still remain uniform conclusion.SGLT2 inhibitor is a new type of hypoglycemic agent,which has the characteristics of improving cardiovascular prognosis and reducing the risk of death,but the benefit mechanism is not completely clear.Studies have shown that improving arterial stiffness may be one of the mechanisms.This study aims to discuss whether SGLT2 inhibitors improve arterial stiffness in people with diabetes.There are still no unified conclusions about strategies related to arterial stiffness in diabetic patients,such as diet control,aerobic exercise,and drugs for AGE cross-linking.SGLT2 inhibitor is a new type of hypoglycemic agent,which has the characteristics of improving cardiovascular prognosis and reducing the risk of death,but the benefit mechanism is not completely clear.Studies have shown that improving arterial stiffness may be one of the mechanisms.This study aims to discuss Whether SGLT2 inhibitors can improve arterial stiffness in diabetic people while lowering blood sugar.Methods:According to the requirements of evidence-based medicine,the corresponding inclusion and exclusion criteria and their search strategies were developed.The Chinese and English controlled searches were performed on Pub Med,Cochrane Library,Clinical Trails,Embase,Web of Science,CNKI,CBM,Vip database,and Wanfang database.The search time is up to November 2019.Randomized controlled trials on blood pressure,pulse wave velocity,systolic pressure,diastolic pressure,BMI and pulse pressure changes in diabetic patients treated with SGLT2 inhibitors were collected,and relevant references were manually searched.The inclusion criteria and exclusion criteria were independently selected by 2 reviewers to perform literature screening,data extraction,and quality evaluation.Meta-analysis was performed on the final included trials using Rev Man 5.3 software and Stata 15 software to compare the pulse wave velocity and pulse pressure of diabetic patients before and after taking the SGLT2inhibitor.According to the size of heterogeneity,the random effect model or fixed effect model is used to combine the effect values.The size of the heterogeneity is represented by I~2,and the effect value is mean difference(MD)and 95%confidence interval(CI).Results:A total of 4 randomized controlled trials(related studies about 2 empagliflozin and 2 dapagliflozin)were included,a total of 177 patients with type 1 and type 2diabetes,including 40 patients with type 1 diabetes and 137 patients type 2 diabetes were followed up for 4 weeks to 8 weeks.Meta analysis results show:(1)Compared with the control group,SGLT2 inhibitors can significantly decrease fasting blood glucose levels(MD=-1.06,95%CI:-1.41 to-0.72,p<0.00001),SBP(MD=-3.56,95%CI:-6.04 to-1.09,p=0.005),DBP(MD=-1.97,95%CI:-3.58 to-0.36,p=0.02),the differences were statistically significant.Compared with the control group,there was no significant difference in BMI changes after SGLT2 inhibitor treatment(MD=-0.43,95%CI:-1.86 to 0.99,p=0.55).(2)SGLT2 inhibitor can significantly reduce the pulse wave conduction velocity(MD=-0.44,95%CI:-0.84 to-0.04,p=0.03),the difference is statistically significant,and there is no obvious heterogeneity in this result(I2=0%,p=0.54);SGLT2 inhibitor can reduce PP,the difference is statistically significant(MD=-2.82,95%CI:-5.41 to-0.23,p=0.03),the result is not obvious heterogeneity(I2=0%,p=0.56).By excluding individual documents one by one and conducting a sensitivity analysis,the result is more robust.The bias analysis indicates that the Egger’s test results show that there may be a publication bias in the PWV change study after SGLT2 inhibitor treatment.The result of the PP change study after SGLT2 inhibitor treatment shows P=0.719 suggests that there is no publication bias.Conclusion:SGLT2 inhibitors can improve arterial stiffness in diabetic patients while lowering blood pressure and glucose,but the mechanism and results still need to be further confirmed by randomized controlled clinical trials with large samples and multiple centers. |
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