Abstract

Smokey Women's Top Lace Queens Canada Low Grey Pajar Up Background: Clinicians and patients need updated evidence on the comparative effectiveness and safety of diabetes medications to make informed treatment choices. Purpose: To evaluate the comparative effectiveness and safety of monotherapy (thiazolidinediones, metformin, sulfonylureas, dipeptidyl peptidase-4 [DPP-4] inhibitors, sodium-glucose cotransporter 2 [SGLT-2] inhibitors, and glucagon-like peptide-1 [GLP-1] receptor agonists) and selected metformin-based combinations in adults with type 2 diabetes. Data Sources: English-language studies from MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials, indexed from inception through March 2015 (MEDLINE search updated through December 2015). Study Selection: Paired reviewers independently identified 179 trials and 25 observational studies of head-to-head monotherapy or metformin-based combinations. Data Extraction: Two reviewers independently assessed study quality and serially extracted data and graded the strength of evidence. Data Synthesis: Cardiovascular mortality was lower for metformin versus sulfonylureas; the evidence on all-cause mortality, cardiovascular morbidity, and microvascular complications was insufficient or of low strength. Reductions in hemoglobin A1c values were similar across monotherapies and metformin-based combinations, except that DPP-4 inhibitors had smaller effects. Body weight was reduced or maintained with metformin, DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT-2 inhibitors and increased with sulfonylureas, thiazolidinediones, and insulin (between-group differences up to 5 kg). Hypoglycemia was more frequent with sulfonylureas. Gastrointestinal adverse events were highest with metformin and GLP-1 receptor agonists. Genital mycotic infections were increased with SGLT-2 inhibitors. Limitation: Most studies were short, with limited ability to assess rare safety and long-term clinical outcomes. Conclusion: The evidence supports metformin as first-line therapy for type 2 diabetes, given its relative safety and beneficial effects on hemoglobin A1c, weight, and cardiovascular mortality (compared with sulfonylureas). On the basis of less evidence, results for add-on therapies to metformin were similar to those for monotherapies.

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Language English (US)
Pages 740-751
Number of pages 12
Journal Annals of Internal Medicine
Top Canada Lace Low Queens Smokey Pajar Grey Up Women's Volume 164
Issue number 11
DOIs
State Grey Lace Up Top Women's Low Queens Pajar Canada Smokey Published -Jun 7 2016

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Canada Pajar Low Queens Up Lace Smokey Top Grey Women's Metformin
Type 2 Diabetes Mellitus
Meta-Analysis
Sodium-Glucose Transport Proteins
Dipeptidyl-Peptidase IV Inhibitors
Thiazolidinediones
MEDLINE
Mortality
Hemoglobins
Aptitude
Information Storage and Retrieval
Hypoglycemia
Observational Studies
Language
Body Weight
Insulin
Morbidity
Weights and Measures

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Maruthur, N. M. , Tseng, E.Leather Grenow Women's Bandolino Bandolino Women's Black qF1X6 , Hutfless, S. , Wilson, L. M., Suarez-Cuervo, C. , Berger, Z., ... Bolen, S. (2016). Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes: A systematic review and meta-analysis. Annals of Internal Medicine, 164(11), 740-751. DOI: Up Pajar Lace Top Low Smokey Women's Queens Grey Canada 10.7326/M15-2650