Sodium-glucose cotransporter 2 inhibitor plus pioglitazone vs pioglitazone alone in patients with diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials

[[abstract]]Aims: To evaluate the efficacy and safety of combined therapy with sodium-glucose cotransporter 2 (SGLT-2) inhibitors plus pioglitazone versus pioglitazone alone in type 2 diabetic patients. Materials and Methods: Systematic literature searches were performed across PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov from 1966 to September 2018 to identify randomized, controlled trials. Mean difference (MD) or odds ratio (OR) was used to evaluate efficacy and safety end-points (active group vs control group), wherever appropriate. Heterogeneity was assessed by P value of chi(2) statistics and I (2). Results: Four randomized controlled trials with 1411 diabetic patients were included. Pooling data from included trials showed that HbA1c change was significantly larger in both low-dose SGLT-2 inhibitors (MD: -0.59%, 95% CI: -0.77 to -0.41%) and high-dose SGLT-2 inhibitors (MD: -0.65%, 95% CI: -0.78 to -0.53%) plus pioglitazone than pioglitazone alone in 24-26 weeks. Favourable outcomes were also found in fasting blood glucose level reduction and more patients achieving HbA1c