From Medscape Medical News

April 11, 2012 — The top 3 drugs for the reduction of glycated hemoglobin A1c (A1C) levels are biphasic insulin, glucagon-like peptide 1 (GLP-1) analogs, and basal insulin. Although most oral antidiabetic drugs had a similar effect on A1C, GLP-1 analogs had the additional advantages of weight reduction in the absence of an increased risk for hypoglycemia.

Sung-Chen Liu, MD, from the Mackay Memorial Hospital, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei, Taiwan, and colleagues published their network meta-analysis of different treatments for diabetes online April 9 in Diabetes, Obesity and Metabolism. The meta-analysis examined the use of antidiabetic agents for the treatment of type 2 diabetes that was inadequately controlled by metformin.

The authors searched PubMed and the Cochrane Central Register of Controlled Trials for randomized controlled trials written in English through December 2011. The search identified 819 articles, 70 of which were reviewed as full-text articles. The authors included 39 randomized controlled trials involving 17,860 patients.

Previous reports indicated that A1C reductions ranged from −0.64% for alpha-glucosidase inhibitors to −0.97% for GLP-1 analogs. The results of this study are consistent with those of previous network meta-analyses.

GLP-1 analogs resulted in greater decrease in A1C levels compared with sulfonylureas (−0.20%; 95% confidence interval [CI], −0.34% to −0.04%), glinides (−0.31%; 95% CI, −0.61% to −0.02%), thiazolidinediones (−0.20%; 95% CI, −0.38% to −0.00%), α-glucosidase inhibitors (−0.36%; 95% CI, −0.64% to −0.07%), and dipeptidyl peptidase IV inhibitors (DPP-4 inhibitors; −0.32%; 95% CI, −0.47 to −0.17%), and resulted in A1C levels comparable to basal insulin and biphasic insulin.

The decrease in A1C levels was greater for sulfonylureas compared with DPP-4 inhibitors (−0.12%; 95% CI, −0.23% to −0.03%), and for biphasic insulin compared with glinides (−0.36%; 95% CI, −0.82% to −0.11%).

The authors found that sulfonylureas, glinides, basal insulin, and biphasic insulin treatments were associated with an increased risk for hypoglycemia compared with placebo.

Patients receiving sulfonylureas, glinides, thiazolidinediones, basal insulin, and biphasic insulin gained weight, and patients receiving glucosidase inhibitors and GLP-1 analogues lost weight. The authors acknowledge that their analysis was limited by the fact that the duration of treatment was only 12 to 52 weeks.

The authors have disclosed no relevant financial relationships.

Diabetes Obes Metab. Published online April 9, 2012. Abstract

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