Comparing Medications for Adults With Type 2 Diabetes
Details of HbA1c and Weight Intermediate Outcomes: Comparisons of Two-Drug Combination Therapies
The combination of metformin plus thiazolidinedione had similar efficacy in reducing HbA1c compared to the combination of metformin plus sulfonylurea, with moderate strength of evidence. Nine other combination therapy comparisons had low strength of evidence, making it difficult to draw firm conclusions. However, the majority showed similar efficacy in reducing HbA1c.
Metformin plus sulfonylurea had a more favorable effect on weight compared with both the combinations of a thiazolidinedione plus sulfonylurea (between-group difference of -3.2 kg, 95 percent CI, -5.2 kg to -1.1 kg) and metformin plus a thiazolidinedione (between-group difference of -0.9 kg, 95 percent CI, -1.3 kg to -0.4 kg). Both comparisons had moderate strength of evidence. Several combination therapies, metformin plus sulfonylurea, metformin plus thiazolidinedione, metformin plus basal insulin, and metformin plus DPP-4 inhibitor, were compared with metformin plus GLP-1 receptor agonists, all favoring the combination of metformin plus GLP-1 receptor agonist which decreased weight. While all the individual comparisons were graded as low evidence, the data as a whole suggested a beneficial effect on weight for the combination of metformin plus GLP-1 receptor agonist compared with several other standard combination therapies. The range in between-group differences was 1.9 kg to 12.3 kg, and all but one study had less than a 5 kg between-group difference. The combination of metformin plus DPP-4 inhibitors decreased weight when compared with the combinations of metformin plus thiazolidinedione or metformin plus sulfonylurea. While these individual comparisons are graded as low strength of evidence due to few studies with the same comparators, the data suggest that metformin plus DPP-4 inhibitors may have a more favorable effect on weight than the other two standard combinations. The range of between-group differences was small (1.5 kg to 2.5 kg).
- Bennett WL, Wilson LM, Bolen S, et al. Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update. Comparative Effectiveness Review No. 27. (Prepared by Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018.) AHRQ Publication No. 11-EHC038-EF. Rockville, MD: Agency for Healthcare Research and Quality. March 2011. Available at: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=644.
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