This metanalysis studied the use of antidiabetes meds in the treatment of diabetes that was inadequately controlled by metformin.
Effect of antidiabetic agents added to metformin on glycemic control, hypoglycemia and weight change in patients with type 2 diabetes: a network meta-analysis
Diabetes, Obesity and MetabolismAccepted Articles,
Accepted manuscript online: 9 APR 2012
Important points about this study:
Metformin is now the accepted first line therapy for type 2 diabetes but many patients on this medication need additional medications to achieve glycemic control as measured by Hgb A1c.
This study attempts to identify what is the best second-line choice and they found that the 3 best drugs for the reducing A1C levels are biphasic insulin, glucagons-like peptide 1 (GLP-1) analogues, and basal insulin.
They peformed a metaanalysis and included 39 randomized controlled trials involving 17,860 patients
(For those concerned that the BLOOM-DM study was too small, the average number of patients in the 39 studies is about 450. I’d also like to point out that the BLOOM, BLOSSOM, BLOOM DM studies had about 8700 patients in 3 studies which is half of the number of patients in the 39 studies above.)
Historical reductions in A1c for alpha-glucosidase inhibitors are -0.64% and for GLP-1 are -0.97% in previous meta-analyses.
In this study GLP-1 resulted in greater decreases in A1C compared with sulfonylureas (-.20%), glinides (-.31%), thiazolidinediones (-.20%), alpha-glucosidase inhibitiors (-.36%) and DPP-4 inhibitors (-.32%).
Sulfonylureas, glinides, basal insulin, and biphasic insulin treatments had increased risks for hypoglycemia. These were also associated with weight gain. Patients using alph-glucosidase inhibitors and GLP-1 analogies lost weight but the same magnitude as the patients on the BLOOM-DM study.
REMEMBER, patients on lorcaserin had a decrease of 0.9% in A1c levels and had significant weight loss without significant symptomatic episodes of hypoglycemia.