Comparative Effectiveness of Glucose-Lowering Drugs for Type 2 Diabetes

医学 赛马鲁肽 二甲双胍 恩帕吉菲 利拉鲁肽 2型糖尿病 杜拉鲁肽 内科学 卡格列净 艾塞那肽 糖尿病 磷酸西他列汀 达帕格列嗪 药理学 胰岛素 内分泌学
作者
Απόστολος Τσάπας,Ioannis Avgerinos,Thomas Karagiannis,Konstantinos Malandris,Apostolos Manolopoulos,P Andréadis,Aris Liakos,David R. Matthews,Eleni Bekiari
出处
期刊:Annals of Internal Medicine [American College of Physicians]
卷期号:173 (4): 278-286 被引量:226
标识
DOI:10.7326/m20-0864
摘要

Background: Several pharmacologic options for type 2 diabetes are available. Purpose: To compare benefits and harms of glucose-lowering drugs in adults with type 2 diabetes. Data Sources: Several databases from inception through 18 December 2019 and ClinicalTrials.gov on 10 April 2020. Study Selection: English-language randomized trials that had at least 24 weeks of intervention and assessed the effects of glucose-lowering drugs on mortality, glycemic, and vascular outcomes. Data Extraction: Pairs of reviewers extracted data and appraised risk of bias. Data Synthesis: 453 trials assessing 21 antidiabetic interventions from 9 drug classes were included. Interventions included monotherapies (134 trials), add-on to metformin-based therapies (296 trials), and monotherapies versus add-on to metformin therapies (23 trials). There were no differences between treatments in drug-naive patients at low cardiovascular risk. Insulin regimens and specific glucagon-like peptide-1 receptor agonists (GLP-1 RAs) added to metformin-based background therapy produced the greatest reductions in hemoglobin A1c level. In patients at low cardiovascular risk receiving metformin-based background treatment (298 trials), there were no clinically meaningful differences between treatments for mortality and vascular outcomes. In patients at increased cardiovascular risk receiving metformin-based background treatment (21 trials), oral semaglutide, empagliflozin, liraglutide, extended-release exenatide, and dapagliflozin reduced all-cause mortality. Oral semaglutide, empagliflozin, and liraglutide also reduced cardiovascular death. Odds of stroke were lower with subcutaneous semaglutide and dulaglutide. Sodium–glucose cotransporter-2 (SGLT-2) inhibitors reduced heart failure hospitalization and end-stage renal disease. Subcutaneous semaglutide and canagliflozin increased diabetic retinopathy and amputation, respectively. Limitation: Inconsistent definitions of cardiovascular risk and low-level confidence in some estimates for patients at low cardiovascular risk. Conclusion: In diabetic patients at low cardiovascular risk, no treatment differs from placebo for vascular outcomes. In patients at increased cardiovascular risk receiving metformin-based background therapy, specific GLP-1 RAs and SGLT-2 inhibitors have a favorable effect on certain cardiovascular outcomes. Primary Funding Source: European Foundation for the Study of Diabetes, supported by an unrestricted educational grant from AstraZeneca. (PROSPERO: CRD42019122043)
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