Incretin mimetics and sodium-glucose co-transporter 2 inhibitors as monotherapy or add-on to metformin for treatment of type 2 diabetes: a systematic review and network meta-analysis
| Autor: | Rongwu Xiang, Ruobing Han, Shubing Jia, Xiaotong Qin, Zhiying Wang, Yuping Li, Zinv Zhang, Jingyu Yang, Mingyi Zhao |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
endocrine system diseases Endocrinology Diabetes and Metabolism Network Meta-Analysis 030209 endocrinology & metabolism Type 2 diabetes Dipeptidyl peptidase-4 inhibitor 030204 cardiovascular system & hematology Cochrane Library Hypoglycemia Lower risk Incretins 03 medical and health sciences 0302 clinical medicine Endocrinology Internal medicine Diabetes mellitus Internal Medicine medicine Humans Hypoglycemic Agents Sodium-Glucose Transporter 2 Inhibitors Glycated Hemoglobin Clinical Trials as Topic Dipeptidyl-Peptidase IV Inhibitors business.industry nutritional and metabolic diseases General Medicine medicine.disease Metformin Treatment Outcome Diabetes Mellitus Type 2 Meta-analysis Drug Therapy Combination business medicine.drug |
| Zdroj: | Acta diabetologica. 58(1) |
| ISSN: | 1432-5233 |
| Popis: | Although there are many different methods of treating type 2 diabetes (T2D), it is still difficult to draw coincident conclusions concerning the efficacy and safety of different classes of new drugs, and the recommendation level of them has still kept uncertain as second anti-diabetic agents. Therefore, the aim of this study was to summarize evidence on the efficacy and safety of DPP-4is, GLP-1RAs and SGLT-2is as monotherapy or add-on to metformin (Met) for treatment of T2D. We searched PubMed, Embase, Cochrane library and ClinicalTrials.gov for relevant articles in keeping with established methods using terms associated with anti-diabetic agents up to February, 2020, with no start date restriction. Weighted mean difference and risk ratios with 95% confidence intervals were calculated within traditional and network meta-analysis. Primary outcomes were the mean change in hemoglobin A1c (HbA1c), fasting plasma glucose (FPG) change and the frequency of hypoglycemic events from baseline after 12 weeks of treatment. In total, 64 eligible studies comprising 37,780 patients and 7 treatment strategies were included. The results of primary outcomes showed that GLP-1RAs were significantly more effective than DPP-4is or SGLT-2is in reducing HbA1c when add-on to Met. For FPG, both GLP-1RAs and SGLT-2is significantly reduced FPG compared with DPP-4is whether add-on to Met or not. For hypoglycemia, monotherapy has a lower risk than combination therapy except for SGLT-2is. Ranking probability analysis indicated that GLP-1RAs and SGLT-2is, respectively, reduced HbA1c and FPG most when add-on to Met. Meanwhile, GLP-1RAs took the lowest risk to induce the hypoglycemia, whereas GLP-1RAs plus Met the highest. Both GLP-1RAs and SGLT-2is have their own advantages in efficacy and safety. Monotherapy is beneficial for reducing the risk of hypoglycemia. The recommendation should be a patient-centered approach when selecting treatment choices. |
| Databáze: | OpenAIRE |
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