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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.
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 …