Third-line therapy for patients with type 2 diabetes inadequately controlled with metformin and a sulfonylurea
Canadian Agency for Drugs and Technologies in Health (CADTH)
Record ID 32012000843
English
Authors' objectives:
What is the comparative efficacy and safety of third-line antidiabetes drugs in children and adults with type 2 diabetes mellitus treated with a combination of metformin and sulfonylureas who require additional or alternative glucose-lowering therapy due to inadequate glycemic control on existing therapy or intolerable adverse effects/contraindications to metformin and/or sulfonylureas?
Authors' recommendations:
There was insufficient evidence to evaluate the comparative efficacy of third-line antidiabetes drugs in
reducing clinically important long-term complications of diabetes. Compared with continued treatment with
metformin and sulfonylureas, DPP-4 inhibitors, GLP-1 analogues, TZDs, and bolus insulin produced
statistically significant reductions in A1C in combination with metformin and sulfonylureas, whereas
meglitinides and alpha-glucosidase inhibitors did not. Basal insulin, biphasic insulin, bolus insulin, and
TZDs all resulted in an increase in body weight, while DPP-4 inhibitors, alpha-glucosidase inhibitors, and
GLP-1 analogues were not associated with significant weight gain. The various insulin-containing
strategies were typically associated with a greater risk of hypoglycemia relative to other active
comparators. Given the similar efficacy in terms of glycemic control, a cost-effectiveness analysis is
warranted to help define the place in therapy for the various drug classes, particularly newer agents.
Rigourously conducted, longer-term studies with larger sample sizes are required to determine if any of
the available drug classes are superior in reducing diabetes-related complications.
Details
Project Status:
Completed
Year Published:
2010
URL for published report:
http://www.cadth.ca/en/products/therapeutic-reviews/about-therapeutic-reviews/pilot
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
Canada
MeSH Terms
- Humans
- Diabetes Mellitus, Type 2
- Hypoglycemic Agents
- Peptides
- Thiazolidinediones
- Dipeptidyl-Peptidase IV Inhibitors
Contact
Organisation Name:
Canadian Agency for Drugs and Technologies in Health
Contact Address:
600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;
Contact Name:
requests@cadth.ca
Contact Email:
requests@cadth.ca
Copyright:
Canadian Agency for Drugs and Technologies in Health (CADTH)
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