The Resource Diabetes medications for adults with type 2 diabetes : an update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Johns Hopkins University Evidence-based Practice Center ; investigators: Shari Bolen, Eva Tseng, Susan Hutfless, Jodi B. Segal, Catalina Suarez-Cuervo, Zackary Berger, Lisa M. Wilson, Yue Chu, Emmanuel Iyoha, Nisa M. Maruthur

Diabetes medications for adults with type 2 diabetes : an update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Johns Hopkins University Evidence-based Practice Center ; investigators: Shari Bolen, Eva Tseng, Susan Hutfless, Jodi B. Segal, Catalina Suarez-Cuervo, Zackary Berger, Lisa M. Wilson, Yue Chu, Emmanuel Iyoha, Nisa M. Maruthur

Label
Diabetes medications for adults with type 2 diabetes : an update
Title
Diabetes medications for adults with type 2 diabetes
Title remainder
an update
Statement of responsibility
prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Johns Hopkins University Evidence-based Practice Center ; investigators: Shari Bolen, Eva Tseng, Susan Hutfless, Jodi B. Segal, Catalina Suarez-Cuervo, Zackary Berger, Lisa M. Wilson, Yue Chu, Emmanuel Iyoha, Nisa M. Maruthur
Creator
Contributor
Author
Issuing body
Sponsoring body
Subject
Genre
Language
eng
Summary
OBJECTIVES: To evaluate the comparative effectiveness and safety of monotherapy and metformin-based combination therapy for type 2 diabetes. DATA SOURCES: We searched MEDLINE(r), Embase(r), and the Cochrane Central Register of Controlled Trials (CENTRAL) for English-language articles using the search developed for the prior review (2011), with date restrictions of April 2009 through April 2015. We searched Drugs@FDA and ClinicalTrials.gov for unpublished data. REVIEW METHODS: Two reviewers independently reviewed titles, abstracts, and full-text articles to identify studies that assessed intermediate and clinical outcomes or safety for monotherapy (metformin, sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 [DPP-4] inhibitors, glucagon-like peptide-1 [GLP-1] agonists, and sodium glucose cotransporter-2 [SGLT-2] inhibitors) or metformin-based combination therapy (metformin plus one of these monotherapy drugs or insulin) comparisons. Two reviewers extracted data from included articles sequentially using standardized protocols; risk of bias was assessed independently. Two reviewers graded the strength of the evidence sequentially using a protocol adapted from the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. RESULTS: We included 216 studies and found moderate- or high-strength evidence for the following. Hemoglobin A1c (HbA1c) reduction was similar across all monotherapy comparisons and across metformin-based combination comparisons except DPP-4 inhibitors, which yielded smaller reductions than metformin. Metformin, DPP-4 inhibitors, GLP-1 agonists, and SGLT-2 inhibitors reduced or maintained body weight, while sulfonylureas, thiazolidinediones, and insulin increased weight; between-group differences ranged from 1 to 5 kilograms. SGLT-2 inhibitors and GLP-1 agonists plus metformin reduced systolic blood pressure by 3 to 5 mmHg compared with metformin. Cardiovascular mortality in studies over 2 years in duration was 50 to 70 percent higher for sulfonylureas than metformin (risk difference, 0.1% to 2.9% in randomized controlled trials). Sulfonylurea-based therapy increased the risk of total and severe hypoglycemia versus most comparisons. Gastrointestinal adverse events were higher with metformin than other drugs except GLP-1 agonists, which increased nausea/vomiting 1.5 times compared with metformin. SGLT-2 inhibitors increased the risk of genital mycotic infections over other drugs. The evidence did not support substantive conclusions for microvascular outcomes, congestive heart failure, cancer, pancreatitis, or other safety outcomes. CONCLUSIONS: Evidence from this updated systematic review supports metformin as firstline therapy, given its beneficial effects on HbA1c, weight, and cardiovascular mortality (relative to sulfonylureas) and its relative safety profile. In addition, evidence on comparative outcomes associated with different medication classes can be used to facilitate personalized treatment choices by patients and clinicians, guideline development, and decisionmaking by payers and regulators
Member of
Cataloging source
NLM
http://bibfra.me/vocab/lite/collectionName
Oral diabetes medications for adults with type 2 diabetes
http://library.link/vocab/creatorName
Bolen, Shari
Funding information
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857; www.ahrq.gov Contract No. 290-2012-00007-I. Prepared by: Johns Hopkins University Evidence-based Practice Center, Baltimore, MD
Government publication
federal national government publication
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • bibliography
  • statistics
NLM call number
WK 825
http://library.link/vocab/relatedWorkOrContributorName
  • United States
  • Effective Health Care Program (U.S.)
  • Johns Hopkins University
Series statement
  • Comparative effectiveness review
  • AHRQ publication
Series volume
  • number 173
  • No. 16-EHC013-EF
http://library.link/vocab/subjectName
  • Diabetes Mellitus, Type 2
  • Hypoglycemic Agents
  • Hypoglycemic Agents
  • Treatment Outcome
  • United States
  • United States
Label
Diabetes medications for adults with type 2 diabetes : an update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Johns Hopkins University Evidence-based Practice Center ; investigators: Shari Bolen, Eva Tseng, Susan Hutfless, Jodi B. Segal, Catalina Suarez-Cuervo, Zackary Berger, Lisa M. Wilson, Yue Chu, Emmanuel Iyoha, Nisa M. Maruthur
Instantiates
Publication
Note
  • "April 2016."
  • "This review updates the 2011 review on oral diabetes medications for adults with type 2 diabetes." Page ES-1
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier
Color
multicolored
Content category
  • text
  • still image
Content type code
  • txt
  • sti
Content type MARC source
  • rdacontent
  • rdacontent
Control code
954194194
Dimensions
unknown
Extent
1 online resource (various pagings)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)954194194
Label
Diabetes medications for adults with type 2 diabetes : an update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Johns Hopkins University Evidence-based Practice Center ; investigators: Shari Bolen, Eva Tseng, Susan Hutfless, Jodi B. Segal, Catalina Suarez-Cuervo, Zackary Berger, Lisa M. Wilson, Yue Chu, Emmanuel Iyoha, Nisa M. Maruthur
Publication
Note
  • "April 2016."
  • "This review updates the 2011 review on oral diabetes medications for adults with type 2 diabetes." Page ES-1
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier
Color
multicolored
Content category
  • text
  • still image
Content type code
  • txt
  • sti
Content type MARC source
  • rdacontent
  • rdacontent
Control code
954194194
Dimensions
unknown
Extent
1 online resource (various pagings)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)954194194

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