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Comparing Medications for Adults With Type 2 Diabetes

Slide: 19 of 35

Details of the Lipid Intermediate Outcomes: Comparisons of Monotherapies

Lipids
Metformin had favorable effects on all the lipid classes. It decreased LDL more effectively than did sulfonylureas, rosiglitazone, or pioglitazone, and it decreased TG more efficiently than sulfonylureas or rosiglitazone. However, pioglitazone was more effective than metformin in decreasing TG. Notably, it seemed that one medication or class may have favorable effects on one lipid outcome and unfavorable effects on another lipid outcome. For instance, rosiglitazone was less effective than pioglitazone in decreasing LDL, and it increased HDL to a lesser extent than did pioglitazone, but both favorably decreased TG.

LDL
Metformin decreased low-density lipoproteins (LDL) while sulfonylureas generally had little effect on LDL (pooled between-group difference favoring metformin of -10.1 mg/dL, 95 percent CI, -13.3 mg/dL to -7.0 mg/dL), with high strength of evidence. Rosiglitazone and pioglitazone increased LDL while metformin decreased LDL with moderate strength of evidence. The pooled between-group differences comparing metformin to rosiglitazone and pioglitazone were -12.8 mg/dL (95 percent CI -24.0 mg/dL to -1.6 mg/dL) and -14.2 mg/dL (95 percent CI, -15.3 mg/dL to - 13.1 mg/dL), respectively. Metformin decreased LDL compared to DPP-4 inhibitors, with a pooled between-group difference of -5.9 mg/dL (95  percent CI -9.8 mg/dL to -2.0 mg/dL), with moderate strength of evidence.

HDL
Pioglitazone increased HDL compared to metformin (pooled between-group difference of 3.2 mg/dL, 95 percent CI 2.1  mg/dL to 5.7 mg/dL) with high strength of evidence. Neither rosiglitazone nor sulfonylureas had an effect on HDL relative to metformin, with high strength of evidence for sulfonylureas and moderate for rosiglitazone. Rosiglitazone increased HDL less than pioglitazone (pooled between-group difference of -2.3 mg/dL, 95 percent CI -3.5 mg/dL to -1.2 mg/dL), with moderate strength of evidence. Pioglitazone increased HDL when compared with sulfonylureas (pooled between-group difference of 4.3 mg/dL, 95 percent CI 1.9 mg/dL to 6.6 mg/dL), with moderate strength of evidence.

TG
Pioglitazone decreased TG more than metformin (pooled between-group difference -27.2 mg/dL, 95 percent CI -30.0 mg/dL to -24.4 mg/dL), with high strength of evidence. Metformin decreased TG relative to rosiglitazone which increased TG (pooled between group difference -26.9 mg/dL, 95 percent CI, -49.3 mg/dL to -4.5 mg/dL), with moderate strength of evidence. Metformin decreased TG compared to sulfonylureas (pooled between-group difference -8.6 mg/dL, 95 percent CI, -15.6 mg/dL to -1.6 mg/dL) with moderate strength of evidence. Sulfonylureas and meglitinides had similar effects on TG (pooled between-group difference 0.2 mg/dL, 95 percent CI, -3.8 mg/dL to 4.2 mg/dL), with moderate strength of evidence.