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Therapeutics/Prevention
Systematic review with meta analysis
Existing evidence is insufficient to justify metformin or other agents as first-line therapy for type 2 diabetes
  1. Rene Rodriguez-Gutierrez1,2,
  2. Victor M Montori3
  1. 1Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Division of Endocrinology, University Hospital ‘Dr. Jose E. Gonzalez’ Autonomous University of Nuevo Leon, Monterrey, Mexico
  3. 3Knowledge and Evaluation Research Unit and Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Victor M Montori, Knowledge and Evaluation Research Unit and Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; montori.victor{at}mayo.edu

https://doi.org/10.1136/ebmed-2016-110562

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    Commentary on: Palmer SC, Mavridis D, Nicolucci A, et al. Comparison of clinical outcomes and adverse events associated with glucose-lowering drugs in patients with type 2 diabetes: a meta-analysis. JAMA 2016;316:313–324OpenUrlCrossRefPubMed.

    Context

    A broad consensus supports the use of metformin as first-line therapy for patients with type 2 diabetes. Clinicians and patients, however, may be interested in using newer antihyperglycaemic drugs as first-line treatment, but their relative advantages to metformin—beyond burden of treatment and hypoglycaemic potential—remain uncertain. The systematic review by Palmer et al sought to evaluate the relative efficacy and safety of glucose-lowering drugs in patients with type 2 diabetes.

    Methods

    A systematic review was conducted of randomised trials testing any drug class for >24 weeks, used alone or in combination to achieve glycaemic control in adults with type 2 diabetes. The primary outcome was cardiovascular mortality. Secondary end points …

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    Footnotes

    • Twitter Follow Victor Montori at @vmontori

    • Disclaimer The KER UNIT of the Mayo Clinic conducts research into shared decision-making, including the design and testing of shared decision-making tools, including the one cited in the commentary which is freely available. The authors derive no income from the use of this free tool: http://shareddecisions.mayoclinic.org

    • Provenance and peer review Commissioned; internally peer reviewed.