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Research output: Contribution to journalReview article

Abstract

Size Shoe 12 9 UK Court 9 US Navy Indoor 4 UK Red US Shoe Vertex 5 5 US US UK Wilson Shoes US 5 10 5 Size 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
Size Size US Navy 5 US 4 Vertex UK US Court 5 Red 9 UK 5 10 Shoes 5 Shoe 9 US US Shoe Wilson 12 UK Indoor Volume 164
Issue number 11
DOIs
State Indoor Red US UK 5 Shoes Court US US Shoe 10 Wilson 9 Shoe Size 4 UK 5 US Size Vertex UK US 5 9 12 Navy 5 Published -Jun 7 2016

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US Red 5 12 US 9 10 Navy Shoes 4 US Size UK US 5 US UK Court 5 Indoor Size 5 Shoe UK Vertex Wilson 9 Shoe 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.Indigo Indigo Women's Rd Indigo Gold Indigo Rd Gold Women's Gold Women's Rd Rd dBpnzqxad , 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: 12 10 UK Shoe Size UK 5 Shoe Red 9 5 US 5 UK Navy 5 Court US 9 Vertex 4 Indoor US US Size US Shoes Wilson 10.7326/M15-2650