Table 4.
GRADE summary of findings to illustrate absolute effects based on cardiovascular and renal risk, for all cause mortality for sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists compared with placebo or each other
| Comparison | Relative effect (odds ratio (95% CI)) | Anticipated absolute effects over five years | Anticipated absolute effects (95% CI) over five years | Certainty in treatment effects (GRADE) | Plain text summary | ||
|---|---|---|---|---|---|---|---|
| Baseline risk* | Risk with control | Risk with intervention | |||||
| SGLT-2 inhibitor v placebo | 0.85 (0.79 to 0.92) | Very low | Placebo: 20 per 1000 | SGLT-2 inhibitor: 17 per 1000 | 3 fewer per 1000 (from 2 fewer to 4 fewer) |
Moderate due to indirectness | SGLT-2 inhibitor treatment probably reduces all cause mortality in people with diabetes and few or no cardiovascular risk factors |
| Low | Placebo: 70 per 1000 | SGLT-2 inhibitor: 60 per 1000 | 10 fewer per 1000 (from 6 fewer to 15 fewer) |
High | SGLT-2 inhibitor treatment reduces all cause mortality in people with diabetes and cardiovascular risk factors | ||
| Moderate | Placebo: 120 per 1000 | SGLT-2 inhibitor: 102 per 1000 | 18 fewer per 1000 (from 10 fewer to 25 fewer) |
High | SGLT-2 inhibitor treatment reduces all cause mortality in people with diabetes and established cardiovascular disease | ||
| High | Placebo: 170 per 1000 | SGLT-2 inhibitor: 144 per 1000 | 26 fewer per 1000 (from 14 fewer to 36 fewer) |
High | SGLT-2 inhibitor treatment reduces all cause mortality in people with diabetes and chronic kidney disease | ||
| Very high | Placebo: 265 per 1000 | SGLT-2 inhibitor: 225 per 1000 | 40 fewer per 1000 (from 21 fewer to 56 fewer) |
High | SGLT-2 inhibitor treatment reduces all cause mortality in people with diabetes and established cardiovascular disease and chronic kidney disease | ||
| GLP-1 receptor agonist v placebo | 0.88 (0.83 to 0.94) | Very low | Placebo: 20 per 1000 | GLP-1 receptor agonist: 18 per 1000 | 2 fewer per 1000 (from 1 fewer to 3 fewer) | Moderate due to indirectness | GLP-1 receptor agonist treatment probably reduces all cause mortality in people with diabetes and few or no cardiovascular risk factors |
| Low | Placebo: 70 per 1000 | GLP-1 receptor agonist: 62 per 1000 | 8 fewer per 1000 (from 4 fewer to 11 fewer) |
High | GLP-1 receptor agonist treatment reduces all cause mortality in people with diabetes and cardiovascular risk factors | ||
| Moderate | Placebo: 120 per 1000 | GLP-1 receptor agonist: 107 per 1000 | 13 fewer per 1000 (from 6 fewer to 18 fewer) |
High | GLP-1 receptor agonist treatment reduces all cause mortality in people with diabetes and established cardiovascular disease | ||
| High | Placebo: 170 per 1000 | GLP-1 receptor agonist: 153 per 1000 | 17 fewer per 1000 (from 9 fewer to 25 fewer) |
High | GLP-1 receptor agonist treatment reduces all cause mortality in people with diabetes and chronic kidney disease | ||
| Very high | Placebo: 265 per 1000 | GLP-1 receptor agonist: 241 per 1000 | 24 fewer per 1000 (from 12 fewer to 35 fewer) |
High | GLP-1 receptor agonist treatment reduces all cause mortality in people with diabetes and established cardiovascular disease and chronic kidney disease | ||
| SGLT-2 inhibitor v GLP-1 receptor agonist | 0.95 (0.86 to 1.06) | Very low | GLP-1 receptor agonist: 18 per 1000 | SGLT-2 inhibitor: 17 per 1000 | 1 fewer per 1000 (from 1 more to 3 fewer) |
Moderate due to indirectness | SGLT-2 inhibitor treatment and GLP-1 receptor agonist treatment probably have similar effects on all cause mortality in people with diabetes and few or no cardiovascular risk factors |
| Low | GLP-1 receptor agonist: 62 per 1000 | SGLT-2 inhibitor: 58 per 1000 | 4 fewer per 1000 (from 4 more to 10 fewer) |
High | SGLT-2 inhibitor treatment and GLP-1 receptor agonist treatment have similar effects on all cause mortality in people with diabetes and cardiovascular risk factors | ||
| Moderate | GLP-1 receptor agonist: 107 per 1000 | SGLT-2 inhibitor: 101 per 1000 | 6 fewer per 1000 (from 7 more to 17 fewer) |
High | SGLT-2 inhibitor treatment and GLP-1 receptor agonist treatment have similar effects on all cause mortality in people with diabetes and established cardiovascular disease | ||
| High | GLP-1 receptor agonist: 153 per 1000 | SGLT-2 inhibitor: 144 per 1000 | 9 fewer per 1000 (from 10 more to 24 fewer) |
High | SGLT-2 inhibitor treatment and GLP-1 receptor agonist treatment have similar effects on all cause mortality in people with diabetes and chronic kidney disease | ||
| Very high | GLP-1 receptor agonist: 241 per 1000 | SGLT-2 inhibitor: 228 per 1000 | 13 fewer per 1000 (from 16 more to 37 fewer) |
High | SGLT-2 inhibitor treatment and GLP-1 receptor agonist treatment have similar effects on all cause mortality in people with diabetes and established cardiovascular disease and chronic kidney disease | ||
GRADE=grading of recommendations assessment, development, and evaluation.
*
Risk categories represent the following patient populations: very low=no or less than three cardiovascular risk factors; low=three or more cardiovascular risk factors; moderate=cardiovascular disease; high=chronic kidney disease (reduced glomerular filtration rate or macroalbuminuria); very high=cardiovascular disease and chronic kidney disease.
The point estimate of the absolute effect for GLP-1 receptor agonist treatment, obtained from GLP-1 receptor agonist treatment versus placebo, was used to calculate the absolute effect for SGLT-2 inhibitors versus GLP-1 receptor agonists.