Thread by @aishaikh

💥New meta-analysis reports CV, Kidney & Mortality outcomes with SGLT2i use with & without Metformin
👉🏽

⚡️Before reviewing the meta-analysis check out this Tweetorial on Should Metformin be the 1st line therapy in T2DM patients?👇🏽
1/ dom-pubs.onlinelibrary.wiley.com/doi/10.1111/do…

https://twitter.com/aishaikh/status/1167550464726044672

⚡️In the meta-analysis, 6 SGLT2i vs Placebo RCTs were included:

-4 trials were CV outcome trials (EMPA-REG, CANVAS, DECLARE-TIMI, VERTIS-CV)

-1 trial was a Kidney outcome trial
(CREDENCE)

-1 trial was a Heart Failure trial
(DAPA-HF)
2/

💥Total number of participants from the 6 RCTs were 51,743

💥Baseline Metformin use varied across the trials as shown below:

⚡️21% in DAPA-HF
⚡️58% in CREDENCE
⚡️74%-82% in EMPA-REG, CANVAS,
DECLARE-TIMI, VERTIS-CV
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💥Results: CV outcome

⚡️SGLT2i ⬇️ major adverse cardiovascular events regardless of baseline Metformin use 👇🏽

⚡️SGLT2i ⬇️ hospitalization for heart failure & CV death👇🏽
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💥Results:Kidney outcome & All-cause mortality

⚡️SGLT2i ⬇️ worsening of kidney function, ESKD, kidney death similarly in pts. receiving Metformin vs patients not receiving Metformin
⚡️SGLT2i ⬇️ risk of all-cause mortality regardless of Metformin use 👇🏽
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💥So should Metformin be the 1st-line therapy for T2DM patients especially the patients at high risk for CV events?
⚡️The European Society of Cardiology changed their recommendations last year - see below👇🏽
⚡️Should other societies follow?
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