Despite accumulating evidence on the potential of glucose-lowering agents (GLAs) to prevent cardiovascular events, the comparative effects of GLAs on vascular function remain unclear. This study utilized validated indicators such as flow-mediated dilation (FMD; positive value favors) and pulse wave velocity (PWV; negative value favors) to uncover the comparative effects of GLAs on vascular function. Randomized controlled trials (RCTs) comparing the effects of GLAs on FMD or PWV with placebo or other GLAs in patients with type 2 diabetes (T2DM) were searched through PubMed and Embase. The frequentist method of network meta-analysis (NMA) was conducted using a random effects model, and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. The NMA included 38 RCTs with 2,065 patients. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium glucose cotransporter‐2 inhibitors (SGLT-2Is) had significantly more positive effects on FMD improvement and PWV reduction than placebo. Thiazolidinedione (TZD) treatment resulted in significantly improved FMD compared to other GLAs as well as placebo (SMD: 1.14; 95% CI: 0.84 to 1.43). Both pioglitazone and rosiglitazone were discovered to have considerably more favorable effects on improving FMD and reducing PWV compared to placebo and other GLAs, as a result of the analysis incorporating each drug in the TZD class. The sensitivity analysis results corroborated the main findings. This NMA showed more favorable effects of GLP-1RAs and SGLT-2Is than placebo in improving both arterial stiffness and endothelial function in patients with T2DM. In addition, TZDs showed superior effects in improving endothelial function as compared with the other GLAs and placebo.

中文翻译：

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降糖药物对 2 型糖尿病患者内皮功能和动脉僵硬度的比较影响：网络荟萃分析

尽管越来越多的证据表明降糖药 (GLA) 预防心血管事件的潜力，但 GLA 对血管功能的相对影响仍不清楚。本研究利用血流介导扩张（FMD；正值优先）和脉搏波速度（PWV；负值优先）等经过验证的指标来揭示 GLA 对血管功能的比较影响。通过 PubMed 和 Embase 检索了比较 GLA 与安慰剂或其他 GLA 对 2 型糖尿病 (T2DM) 患者的 FMD 或 PWV 影响的随机对照试验 (RCT)。使用随机效应模型进行网络荟萃分析（NMA）的频率论方法，并计算具有95%置信区间（CI）的标准化均差（SMD）。 NMA 包括 38 项随机对照试验，涉及 2,065 名患者。胰高血糖素样肽 1 受体激动剂 (GLP-1RA) 和钠葡萄糖协同转运蛋白 2 抑制剂 (SGLT-2Is) 对 FMD 改善和 PWV 降低比安慰剂具有显着更积极的作用。与其他 GLA 以及安慰剂相比，噻唑烷二酮 (TZD) 治疗可显着改善 FMD（SMD：1.14；95% CI：0.84 至 1.43）。通过将 TZD 类别中的每种药物纳入分析，发现与安慰剂和其他 GLA 相比，吡格列酮和罗格列酮在改善 FMD 和降低 PWV 方面具有更有利的效果。敏感性分析结果证实了主要发现。该 NMA 显示 GLP-1RA 和 SGLT-2Is 在改善 T2DM 患者动脉僵硬度和内皮功能方面比安慰剂更有利。此外，与其他 GLA 和安慰剂相比，TZD 在改善内皮功能方面表现出优异的效果。