Meta-Analysis Affirms ADA’s Diabetes Drug Guidelines

Treatment with any of the 9 available classes of glucose-lowering drugs was not associated with improvement in the risk of cardiovascular or all-cause mortality among adults with type 2 diabetes, while treatment with metformin was associated with lower HbA1c levels compared with any other drug classes, according to the results of a recent study. These results are consistent with the American Diabetes Association’s recommendations for metformin monotherapy as initial treatment for type 2 diabetes.

In order to estimate the efficacy and safety associated with the numerous glucose-lowering drugs available for the treatment of type 2 diabetes, researchers conducted a meta-analysis of 301 clinical trials, with 177 trials (56,598 participants) of monotherapy, 109 trials (53,030 participants) of drugs added to metformin (dual therapy), 29 trials (10,598 participants) of drugs added to metformin and sulfonylurea (triple therapy).
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Overall, no significant differences in associations with cardiovascular or all-cause mortality were observed between any drug class as monotherapy, dual therapy, or triple therapy. Sulfonylurea, thiazolidinedione, DPP-4 inhibitor, and α-glucosidase inhibitor monotherapy were associated with higher HbA1c levels compared with metformin. Sulfonylurea and basal insulin were associated with greatest odds of hypoglycemia.

In combination with metformin, all drugs were associated with similar HbA1c levels, with SGLT-2 inhibitors associated with the lowest odds of hypoglycemia. GLP-1 receptor agonists were associated with the lowest risk of hypoglycemia when used in triple therapy.

“These findings are consistent with American Diabetes Association recommendations for using metformin monotherapy as initial treatment for patients with type 2 diabetes and selection of additional therapies based on patient-specific considerations,” the researchers concluded.

—Michael Potts

Reference:

Palmer SC, Mavridis D, Nicolucci A, et al. Comparison of clinical outcomes and adverse events associated with glucose-lowering drugs in patients with type 2 diabetes: a meta-analysis [published online July 19, 2016]. JAMA. doi:10.1001/jama.2016.9400.