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ACP Journal Club |16 January 2018

Review: Newer second-line drugs for diabetes are not more cost-effective than sulfonylureas

Natalia Genere, MD; Victor M. Montori, MD, MSc

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CADTH Therapeutic Reviews. New drugs for type 2 diabetes: second-line therapy–science report. Ottawa, ON: Canadian Agency for Drugs and Technologies in Health; Sep 2017.

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Cardiology:

Endocrinology:

In patients with type 2 diabetes mellitus inadequately controlled on metformin monotherapy, what are the efficacy and safety (Q1) and cost-effectiveness (Q3) of second-line drug classes? What are the cardiovascular (CV) effects of the available drug classes in all patients with type 2 diabetes (Q2)?
Included studies assessed the efficacy and safety (Q1), CV effects (Q2), or cost-effectiveness (Q3) of sulfonylureas (SULs), basal insulin (INS-BA), biphasic insulin (INS-BI), dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) analogues, sodium–glucose cotransporter-2 (SGLT-2) inhibitors, meglitinide, α-glucosidase inhibitors, or thiazolidinediones in patients with type 2 diabetes. Studies of efficacy and safety (Q1) and economic findings (Q3) had to include patients with inadequate glycemic control on metformin monotherapy; studies of CV outcomes (Q2) included patients who were at high risk for CV events and were receiving any background therapy. Studies of treatment for < 4 weeks or in which patients discontinued metformin (Q1) were excluded. Outcomes included hemoglobin (Hb) A1c and hypoglycemia (Q1), major adverse cardiac events and all-cause mortality (Q2), and incremental cost–utility ratios (ICURs) (Q3), among many others.
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Genere N, Montori VM. Review: Newer second-line drugs for diabetes are not more cost-effective than sulfonylureas. Ann Intern Med. ;168:JC8. doi: 10.7326/ACPJC-2018-168-2-008

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Published: Ann Intern Med. 2018;168(2):JC8.

DOI: 10.7326/ACPJC-2018-168-2-008

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2018 American College of Physicians
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