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Comparing Medications for Adults With Type 2 Diabetes

Slide: 18 of 35

Details of HbA1c and Weight Intermediate Outcomes: Comparisons of Monotherapies

Most antidiabetic medications had similar efficacy in achieving reductions in HbA1c, with absolute reduction by around 1 percent compared with baseline values. The strength of evidence was graded high for metformin versus sulfonylurea with a pooled between group difference of 0.1 percent (95 percent confidence interval [CI], -0.1 percent to 0.3 percent). The strength of evidence was graded as moderate for the following comparisons: sulfonylureas versus thiazolidinediones , pioglitazone versus rosiglitazone, metformin versus thiazolidinediones, and sulfonylureas versus repaglinide. Metformin had a greater reduction in hemoglobin A1c (HbA1c) compared with dipeptidyl peptidase-4 (DPP-4) inhibitors, with a pooled between-group difference of -0.4 percent (95 percent CI, -0.5 percent to -0.2 percent), with moderate strength of evidence.

Unlike thiazolidinediones or sulfonylureas, metformin was not associated with weight gain, with a mean difference of about −2.6 kg between metformin and the other drugs, in trials that lasted more than 3 months but generally less than 1 year. Depending on the comparator, these findings were given a moderate to high strength of evidence. As monotherapy, metformin was associated with between-group differences of -2.6 kg when compared with thiazolidinediones, -2.7 kg when compared with sulfonylureas and -1.4 kg when compared with DPP-4 inhibitors  (moderate to high strength of evidence as indicated). Sulfonylureas had similar effects on body weight as the meglitinides when used as  monotherapy, with high strength of evidence. When compared with sulfonylureas, GLP-1 receptor agonists decreased weight (pooled between group  difference of -2.5 kg, 95 percent CI -3.8 kg to -1.1 kg). The strength of evidence was moderate favoring GLP-1 receptor agonists.