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
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.
Project Status: Completed
Year Published: 2010
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
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;
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Copyright: Canadian Agency for Drugs and Technologies in Health (CADTH)
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