Juan Pablo Domecq, MD; Gabriela Prutsky, MD; Victor M. Montori, MD
What are the relative effectiveness and safety of oral drugs, alone and in 2-drug combinations, for treatment of type 2 diabetes in adults?
Included studies compared oral drugs, alone or combined with metformin, a thiazolidinedione (TZD), or insulin therapies, for treatment of type 2 diabetes in nonpregnant patients ≥ 18 years of age; had ≥ 3 months of follow-up; and included ≥ 40 patients. Studies of α-glucosidase inhibitors or colesevelam were excluded. Outcomes included long-term clinical outcomes (all-cause mortality, cardiovascular morbidity and mortality, nephropathy, and neuropathy), hemoglobin A1c (HbA1c) and low-density lipoprotein cholesterol (LDL-C) levels, and hypoglycemia.
MEDLINE (to Dec 2010 for long-term clinical outcomes and Apr 2010 for other outcomes); EMBASE/Excerpta Medica and Cochrane Central Register of Controlled Trials (to Apr 2010); 15 medical journals; trial registries; reports from US, Canadian, and European regulatory agencies; and reference lists were searched for English-language, randomized, controlled trials (RCTs) and observational studies. Reviewers provided additional references, and pharmaceutical companies were contacted. 166 studies, including 140 RCTs, met the selection criteria. Pharmaceutical companies provided support for 95 studies. 25 studies, including 5 RCTs, had a duration > 2 years. Results for the most frequently studied drugs and combinations are reported here.
Limited, mainly low-quality evidence exists on the effectiveness of currently available oral drugs for long-term clinical outcomes. Selected findings for HbA1c and LDL-C levels and hypoglycemia are shown in the Table.
Oral drugs for type 2 diabetes, alone and in combination, have different relative benefits and harms for surrogate endpoints.
Selected findings for oral drugs for treatment of type 2 diabetes in adults*
*DPP-4 = dipeptidyl peptidase-4 inhibitor; LDL-C = low-density lipoprotein cholesterol; MD = mean difference; met = metformin; NR = not reported; SU = sulfonylurea; TZD = thiazolidinedione; other abbreviations defined in Glossary. RRR, RRI, NNT, and CI calculated from data in article. MD < 0 and RRR > 0 indicate benefit for first group; RRI > 0 indicates detriment for first group.
†TZD = pioglitazone.
‡TZD = rosiglitazone.
Domecq JP, Prutsky G, Montori VM. Review: Oral drugs for type 2 diabetes, alone or in combination, have different relative benefits and harms for surrogate endpoints. Ann Intern Med. ;155:JC2–4. doi: 10.7326/0003-4819-155-4-201108160-02004
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Published: Ann Intern Med. 2011;155(4):JC2-4.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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