Association of SGLT2I vs. DPP4I with Pneumonia, COVID-19, and Adverse Respiratory Events in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

OBJECTIVE: To systematically assess the association of Sodium-Glucose Co-Transporter 2 Inhibitors (SGLT2I) vs. Dipeptidyl Peptidase-4 Inhibitors (DPP4I) with pneumonia, COVID-19, and adverse respiratory events in patients with type 2 diabetes mellitus (DM). METHOD: PubMed, Embase, and Cochrane Library databases were retrieved to include studies on DM patients receiving SGLT2I (exposure group) or DPP4I (control group). Stata.15.0 statistical software was employed for meta-analysis. RESULT: Ten studies were included, 10 of which were used for the qualitative review and 7 for the meta-analysis. According to the meta-analysis, patients receiving SGLT2I had lower pneumonia incidence (OR=0.62, 95% Cl, 0.51-0.74) and pneumonia risk (OR=0.63, 95% Cl, 0.60-0.68, P=0.000) compared to those receiving DPP4I. The same situation occurs in mortality rate of pneumonia (OR=0.49, 95% Cl, 0.39-0.60) and pneumonia mortality risk (OR=0.47, 95% Cl, 0.42-0.51) . Lower mortality of COVID-19 (OR=0.31, 95% Cl, 0.28 -0.34), and a lower hospitalization rate and incidence of mechanical ventilation (OR=0.61, 95% Cl, 0.56-0.68, P=0.000, OR=0.69, 95% Cl, 0.58-0.83, P=0.000) due to COVID-19 in patients with type 2 DM receiving SGLT2I. The qualitative analysis results showed that SGLT2I was associated with a lower incidence of COVID-19, lower risk of obstructive Airway disease (OAD) events, and lower hospitalization rate of healthcare-associated pneumonia (HCAP) than DPP4I. CONCLUSION: In patients with type 2 DM, SGLT2I is associated with a lower risk of pneumonia, COVID-19 and mortality rate compared to those taking DPP4I.