Comparative Effectiveness of Glucose-Lowering Drugs for Type 2 Diabetes
| Autor: | Panagiotis Andreadis, Apostolos Tsapas, Aris Liakos, Apostolos Manolopoulos, Konstantinos Malandris, Eleni Bekiari, Thomas Karagiannis, David R. Matthews, Ioannis Avgerinos |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Blood Glucose
medicine.medical_specialty Network Meta-Analysis Type 2 diabetes 01 natural sciences 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Diabetes mellitus Internal medicine Internal Medicine Empagliflozin medicine Humans Hypoglycemic Agents 030212 general & internal medicine 0101 mathematics Dapagliflozin Glycated Hemoglobin Canagliflozin business.industry Semaglutide 010102 general mathematics General Medicine medicine.disease Metformin Treatment Outcome Diabetes Mellitus Type 2 chemistry Dulaglutide business medicine.drug |
| Zdroj: | Annals of Internal Medicine. 173:278-286 |
| ISSN: | 1539-3704 0003-4819 |
| DOI: | 10.7326/m20-0864 |
| Popis: | Background Several pharmacologic options for type 2 diabetes are available. Purpose To compare benefits and harms of glucose-lowering drugs in adults with type 2 diabetes. Data sources Several databases from inception through 18 December 2019 and ClinicalTrials.gov on 10 April 2020. Study selection English-language randomized trials that had at least 24 weeks of intervention and assessed the effects of glucose-lowering drugs on mortality, glycemic, and vascular outcomes. Data extraction Pairs of reviewers extracted data and appraised risk of bias. Data synthesis 453 trials assessing 21 antidiabetic interventions from 9 drug classes were included. Interventions included monotherapies (134 trials), add-on to metformin-based therapies (296 trials), and monotherapies versus add-on to metformin therapies (23 trials). There were no differences between treatments in drug-naive patients at low cardiovascular risk. Insulin regimens and specific glucagon-like peptide-1 receptor agonists (GLP-1 RAs) added to metformin-based background therapy produced the greatest reductions in hemoglobin A1c level. In patients at low cardiovascular risk receiving metformin-based background treatment (298 trials), there were no clinically meaningful differences between treatments for mortality and vascular outcomes. In patients at increased cardiovascular risk receiving metformin-based background treatment (21 trials), oral semaglutide, empagliflozin, liraglutide, extended-release exenatide, and dapagliflozin reduced all-cause mortality. Oral semaglutide, empagliflozin, and liraglutide also reduced cardiovascular death. Odds of stroke were lower with subcutaneous semaglutide and dulaglutide. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors reduced heart failure hospitalization and end-stage renal disease. Subcutaneous semaglutide and canagliflozin increased diabetic retinopathy and amputation, respectively. Limitation Inconsistent definitions of cardiovascular risk and low-level confidence in some estimates for patients at low cardiovascular risk. Conclusion In diabetic patients at low cardiovascular risk, no treatment differs from placebo for vascular outcomes. In patients at increased cardiovascular risk receiving metformin-based background therapy, specific GLP-1 RAs and SGLT-2 inhibitors have a favorable effect on certain cardiovascular outcomes. Primary funding source European Foundation for the Study of Diabetes, supported by an unrestricted educational grant from AstraZeneca. (PROSPERO: CRD42019122043). |
| Databáze: | OpenAIRE |
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