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  • For type 2 diabetes poorly controlled by metformin monotherapy, the addition of any non-insulin antidiabetic drug reduces HbA1c to a similar extent, but with differing effects on weight and hypoglycaemic risk

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Therapeutics
Systematic review
For type 2 diabetes poorly controlled by metformin monotherapy, the addition of any non-insulin antidiabetic drug reduces HbA1c to a similar extent, but with differing effects on weight and hypoglycaemic risk
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  1. Srikanth Bellary
  1. Heartlands Biomedical Research Centre
  1. Correspondence to Srikanth Bellary
    Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B95SS, UK; srikanth.bellary{at}heartofengland.nhs.uk

https://doi.org/10.1136/ebm1116

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    Commentary on:

    1. Phung OJ,
    2. Scholle JM,
    3. Talwar M,
    4. et al
    . Effect of noninsulin antidiabetic drugs added to metformin therapy on glycemic control, weight gain, and hypoglycemia in type 2 diabetes. JAMA 2010;303:1410–18.
    OpenUrlCrossRefPubMed

    Context

    Current guidelines recommend metformin as initial therapy in patients with type 2 diabetes.1 With time, as β cell function declines, most patients require additional therapy.2 While there is now an expanding list of drugs available to be used as second-line agents, studies that directly compare the efficacy of these agents are lacking.1 The choice of a second-line agent is, therefore, less clear. In this meta-analysis, Phung and colleagues address this important issue and evaluate the efficacy of currently available non-insulin diabetes therapies.

    Methods

    The investigators used a combination of traditional and mixed-treatment comparison meta-analysis approach to evaluate the glycaemic and non-glycaemic effects of the different classes of drugs. Studies were identified using a systematic literature search of MEDLINE and Cochrane databases from 1950 to January 2010. Only parallel-design randomised controlled trials (RCT) that evaluated the combination of non-insulin hypoglycaemic agents in patients poorly controlled on stable doses (at least 1500 mg/day) of metformin and were in treatment for 12–52 weeks duration were included. Outcome measures included changes in HbA1c, achievement of target HbA1c <7%, hypoglycaemic …

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