Diabetes: glycaemic control in type 2 (drug treatments)

Overview

Abstract | Cite as | Substantive changes

Abstract

INTRODUCTION: Diabetes mellitus is a progressive disorder of glucose metabolism. It is estimated that about 285 million people between the ages of 20 and 79 years had diabetes worldwide in 2010, or 5% of the adult population. Type 2 diabetes may occur with obesity, hypertension, and dyslipidaemia (the metabolic syndrome), which are powerful predictors of cardiovascular disease. Without adequate blood-glucose-lowering treatment, blood glucose levels may rise progressively over time in people with type 2 diabetes. Microvascular and macrovascular complications may develop. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of blood-glucose-lowering medications in adults with type 2 diabetes? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 194 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: alpha-glucosidase inhibitors (AGIs), combination treatment (single, double, and triple), dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) analogues, insulins (including conventional [human] and analogue, different regimens, different length of action), meglitinides, metformin, sulphonylureas, and thiazolidinediones.

Cite as

Gorter KJ, de Laar FAv, Janssen PGH, Houweling ST and Rutten GEHM. Diabetes: glycaemic control in type 2 (drug treatments). Clinical Evidence 2012; 10:609.

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Substantive changes

Metformin versus placebo or other blood-glucose-lowering agents New option added.[9][10][11][12][13][15][16][20][21][22][23][24][25][26][27][28]Categorised as Beneficial.

Metformin plus sulphonylurea versus sulphonylurea alone New option added.[10][29][30][31] Categorised as Unknown effectiveness.

Sulphonylureas versus placebo or other blood-glucose-lowering agents New option added.[9][10][13][14][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] Categorised as Beneficial.

Meglitinides versus placebo or other blood-glucose-lowering agents New option added.[9][10][14][15][16][38][39][40][41][42][50][51][52] Categorised as Likely to be beneficial.

Alpha-glucosidase inhibitors (AGIs) versus placebo or other blood-glucose-lowering agents New option added.[9][10][14][53][54][55][56][57][58][59][60][61][62][64] Categorised as Likely to be beneficial.

Thiazolidinediones versus placebo or other blood-glucose-lowering agents New option added.[9][10][13][17][20][33][34][35][37][65][66][67][68][69][70][71][72][73][74][75][76][77][78][80][81][82][83][84][85][86][87][88][89][90][91][92][94][95] Categorised as Trade-off between benefits and harms.

Glucagon-like peptide-1 (GLP-1) analogues versus placebo or other blood-glucose-lowering agents New option added.[46][47][48][49][96][97][98][99][100][101][102][103][104][105][106][107][108][109] Categorised as Likely to be beneficial.

Dipeptidyl peptidase-4 (DPP-4) inhibitors versus placebo or other blood-glucose-lowering agents New option added.[20][21][22][23][24][25][26][27][28][43][44][45][95][110][111][112][113][114][115][116][117][118][119] Categorised as Likely to be beneficial.

Insulin as first-line treatment followed by continuation of insulin versus metformin plus sulphonylurea New option added.[121] Categorised as Unknown effectiveness.

Various insulin analogue regimens versus various conventional (human) insulin regimens New option added.[122][123][124][125][126][127][128][129][130][131][132][133][134][135][136][137][138][139][140][141][142][143][144][145][146][147][148][149][150][151][152][153][154][155][156][157][158][159][160][161][162][163][164] Categorised as Unlikely to be beneficial.

Insulin long-acting analogues versus each other New option added.[143][166][167][168][169] Categorised as Likely to be beneficial.

Insulin plus single oral blood-glucose-lowering medication versus insulin alone or insulin plus another oral blood-glucose-lowering medication New option added.[31][78][79][133][149][170][171][172][173][174][175][176][177][178][179] Categorised as Likely to be beneficial.

One insulin analogue (short-, intermediate-, long-acting) treatment regimen versus another insulin analogue (short-, intermediate-, long-acting) treatment regimen (excluding long-acting analogue versus long-acting analogue) New option added.[133][158][162][180][181][182][183][184][185][186][187][188][189][190][191][192][193][194][195][196][197][198][199][200][201] Categorised as Unknown effectiveness.

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