Comparative Effectiveness of Glucose-Lowering Drugs for Type 2 Diabetes

Τσάπας, Απόστολος; Avgerinos, Ioannis; Karagiannis, Thomas; Malandris, Konstantinos; Manolopoulos, Apostolos; Andréadis, P; Liakos, Aris; Matthews, David R.; Bekiari, Eleni

doi:10.7326/m20-0864

Cited by 224 publications

(145 citation statements)

References 34 publications

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“…Second, the present study only assessed the clinical effectiveness of GLP-1RAs in terms of short-term clinical biochemical marker changes (e.g., HbA1c, eGFR), while the hard endpoints of treatments (e.g., cardiovascular disease, death, progression to end-stage renal disease) were not measured. To date, there is a lack of direct head-to-head comparative trials of GLP-1RAs on the long-term cardiovascular safety and mortality, but there are indirect comparisons from three network meta-analysis studies [ 42 – 44 ]. This suggests that future studies with the long-term follow-up period on hard outcomes among GLP-1RAs are needed.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of dulaglutide versus liraglutide in Asian type 2 diabetes patients: a multi-institutional cohort study and meta-analysis

Chang

Shao

Kuo

et al. 2020

Cardiovasc Diabetol

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Background Head-to-head comparison of clinical effectiveness between dulaglutide and liraglutide in Asia is limited. This study was aimed to assess the real-world comparative effectiveness of dulaglutide versus liraglutide. Methods We conducted a retrospective cohort study by utilizing multi-institutional electronic medical records to identify real-world type 2 diabetes patients treated with dulaglutide or liraglutide during 2016–2018 in Taiwan and followed up until 2019. Effectiveness outcomes were assessed at every 3 months in the 1-year follow-up. Propensity score techniques were applied to enhance between-group comparability. Significant differences in changes of effectiveness outcomes between treatment groups during the follow-up were examined and further analyzed using mixed-model repeated-measures approaches. Results A total of 1512 subjects receiving dulaglutide and 1513 subjects receiving liraglutide were identified. At 12 months, significant HbA1c changes from baseline were found in both treatments (dulaglutide: − 1.06%, p < 0.001; liraglutide: − 0.83%, p < 0.001), with a significant between-group difference (− 0.23%, 95% confidence interval − 0.38 to − 0.08%, p < 0.01). Both treatments yielded significant declines in weight, alanine aminotransferase level, and estimated glomerular filtration rate from baseline (dulaglutide: − 1.14 kg, − 3.08 U/L and − 2.08 mL/min/1.73 m2, p < 0.01; liraglutide: − 1.64 kg, − 3.65 U/L and − 2.33 mL/min/1.73 m2, p < 0.001), whereas only dulaglutide yielded a significant systolic blood pressure reduction (− 2.47 mmHg, p < 0.001). Between-group differences in changes of weight, blood pressure, and liver and renal functions at 12 months were not statistically significant. Conclusions In real-world T2D patients, dulaglutide versus liraglutide was associated with better glycemic control and comparable effects on changes of weight, blood pressure, and liver and renal functions.

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Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of dulaglutide versus liraglutide in Asian type 2 diabetes patients: a multi-institutional cohort study and meta-analysis

Chang

Shao

Kuo

et al. 2020

Cardiovasc Diabetol

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“…Similar considerations are applied in patients who require a third agent to achieve glycemic goals. A recent systematic review and network metaanalysis suggests greatest reductions in A1C level with insulin regimens and specific GLP-1 RAs added to metformin-based background therapy (52). In all cases, treatment regimens need to be continuously reviewed for efficacy, side effects, and patient burden ( Table 9.1).…”

Section: Combination Therapymentioning

confidence: 99%

9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2021

2020

Diabetes Care

815

527

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The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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“…In addition, most patients with T2DM progress to requiring combination therapy soon after baseline metformin therapy. A recent meta-analysis examining comparative effectiveness of GLTs concluded that the use of metformin as first-line treatment in treatment-naïve individuals with low cardiovascular risk remains justified and given the lack of evidence, they could not reach a conclusion about the optimal initial treatment of treatment-naïve patients at increased cardiovascular risk [44]. Future studies will need to address whether SGLT2i and GLP-1RAs should be used for the prophylaxis of ASCVD and CKD in uncomplicated newly diagnosed treatment-naïve individuals with T2D to address this further.…”

Section: The European Society Of Cardiology (Esc) 2019 Guidelines On mentioning

confidence: 99%

“…HbA1c not only reflects longer-term glycaemic control but improvement in HbA1c correlates with reduced risk of cardiovascular complications [59][60][61]. In a recent meta-analysis, metformin reduced mean HbA1c by −0.92% (95% CI −1.07, −0.77) in treatment-naïve individuals which was lower only to canagliflozin (−1.02% [95% CI −1.68, −0.36]) and oral semaglutide (−1.10%, 95% CI −1.7, −0.45) amongst oral GLTs [44]. Metformin has been found to improve glycaemic variables significantly (both fasting blood glucose and HbA1c) compared to placebo in a dose-dependent fashion at dosages of 500 to 2000 mg daily, with maximal benefits observed at upper limits of recommended daily dosage [62].…”

Section: Efficacy Of Metformin As a Glucose-lowering Agentmentioning

confidence: 99%

Where Does Metformin Stand in Modern Day Management of Type 2 Diabetes?

et al. 2020

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Metformin is the most commonly used glucose-lowering therapy (GLT) worldwide and remains the first-line therapy for newly diagnosed individuals with type 2 diabetes (T2D) in management algorithms and guidelines after the UK Prospective Diabetes Study (UKPDS) showed cardiovascular mortality benefits in the overweight population using metformin. However, the improved Major Adverse Cardiovascular Events (MACE) realised in some of the recent large cardiovascular outcomes trials (CVOTs) using sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have challenged metformin’s position as a first-line agent in the management of T2D. Many experts now advocate revising the existing treatment algorithms to target atherosclerotic cardiovascular disease (ASCVD) and improving glycaemic control as a secondary aim. In this review article, we will revisit the major cardiovascular outcome data for metformin and include a critique of the UKPDS data. We then review additional factors that might be pertinent to metformin’s status as a first-line agent and finally answer key questions when considering metformin’s role in the modern-day management of T2D.

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Comparative Effectiveness of Glucose-Lowering Drugs for Type 2 Diabetes

Cited by 224 publications

References 34 publications

Comparative effectiveness of dulaglutide versus liraglutide in Asian type 2 diabetes patients: a multi-institutional cohort study and meta-analysis

Comparative effectiveness of dulaglutide versus liraglutide in Asian type 2 diabetes patients: a multi-institutional cohort study and meta-analysis

9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2021

Where Does Metformin Stand in Modern Day Management of Type 2 Diabetes?

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