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Comparative Effectiveness of Treatments Explored in T2DM

Greatest drop in HbA1c for insulin, specific glucagon-like peptide-1 receptor agonist added to metformin

TUESDAY, June 30, 2020 (HealthDay News) -- For patients with type 2 diabetes at low cardiovascular risk, there are no differences in vascular outcomes between treatments, according to research published online June 30 in the Annals of Internal Medicine.

Apostolos Tsapas, M.D., Ph.D., from the Aristotle University of Thessaloniki in Greece, and colleagues compared the benefits and harms of glucose-lowering drugs in adults with type 2 diabetes using data from 453 trials assessing 21 antidiabetic interventions from nine drug classes. The interventions included monotherapies (134 trials), add-on to metformin-based therapies (296 trials), and monotherapies versus add-on to metformin therapies (23 trials).

The researchers found that for drug-naive patients at low cardiovascular risk, there were no differences between treatments. The greatest reductions in hemoglobin A1c level were seen with insulin regimens and specific glucagon-like peptide-1 receptor agonists added to metformin-based background therapy. No clinically meaningful differences were seen for mortality or vascular outcomes between treatments in patients at low cardiovascular risk receiving metformin-based background treatment. All-cause mortality was reduced in patients at increased cardiovascular risk receiving metformin-based background treatment, oral semaglutide, empagliflozin, liraglutide, extended-release exenatide, and dapagliflozin. Cardiovascular death was also reduced with oral semaglutide, empagliflozin, and liraglutide. Lower odds of stroke were seen with subcutaneous semaglutide and dulaglutide.

"The use of metformin as first-line treatment of drug-naive patients at low cardiovascular risk seems justified," the authors write.

The study was partially funded by an unrestricted grant from AstraZeneca.

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