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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
  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}

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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 …

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