Early combination therapy for the treatment of type 2 diabetes mellitus: systematic review and meta-analysis - PubMed (original) (raw)
Review
doi: 10.1111/dom.12233. Epub 2013 Dec 16.
Affiliations
- PMID: 24205921
- DOI: 10.1111/dom.12233
Review
Early combination therapy for the treatment of type 2 diabetes mellitus: systematic review and meta-analysis
O J Phung et al. Diabetes Obes Metab. 2014 May.
Abstract
Aims: Guidelines for type 2 diabetes recommend add-on agents when metformin alone fails to provide adequate glycaemic control. However, early combination therapy may benefit health outcomes. We conducted a systematic review and meta-analysis to investigate this question.
Methods: We searched MEDLINE and Cochrane CENTRAL (up to July 2012) without language restrictions. We sought randomized controlled trials (RCTs) evaluating initial combination therapy with metformin versus metformin monotherapy in patients with untreated type 2 diabetes. Weighted mean differences (WMDs) for changes from baseline and relative risks (RRs) [with 95% confidence intervals (CIs)] were calculated using random-effects model.
Results: In 15 RCTs (N = 6693), the mean age range was 48.4-62.7 years; mean baseline glycosylated haemoglobin (A1c) was 7.2-9.9% and mean diabetes duration was 1.6-4.1 years, with median follow-up of 6 months and with 13 comparisons for A1c change, 14 comparisons for A1c goal attainment of <7% and 13 comparisons for change in fasting plasma glucose (FPG). Drugs combined with metformin included thiazolidinediones (TZDs), insulin secretagogues, dipeptidyl peptidase-4 (DPP-4) inhibitors or sodium glucose transporterase (SGLT-2) inhibitors. Compared to metformin alone, combination therapy with metformin provided statistically significant reductions in A1c (WMD -0.43%, 95% CI -0.56, -0.30), increases in attainment of A1c goal of less than 7% (RR 1.40, 95% CI 1.33-1.48) and reductions in FPG (WMD -14.30 mg/dl, 95% CI -16.09, -12.51).
Conclusions: These results suggest a potential benefit of initial combination therapy on glycaemic outcomes in diabetes compared to metformin monotherapy across a wide range of baseline A1c levels. Further research should explore if early combination treatment may also affect longer term health outcomes in diabetes.
Keywords: antidiabetic drug; diabetes mellitus; medicines management; meta-analysis; type 2 diabetes.
© 2013 John Wiley & Sons Ltd.
Similar articles
- Effectiveness of sitagliptin compared to sulfonylureas for type 2 diabetes mellitus inadequately controlled on metformin: a systematic review and meta-analysis.
Sharma M, Beckley N, Nazareth I, Petersen I. Sharma M, et al. BMJ Open. 2017 Oct 30;7(10):e017260. doi: 10.1136/bmjopen-2017-017260. BMJ Open. 2017. PMID: 29084794 Free PMC article. Review. - Efficacy and safety of vildagliptin in patients with type 2 diabetes mellitus inadequately controlled with dual combination of metformin and sulphonylurea.
Lukashevich V, Del Prato S, Araga M, Kothny W. Lukashevich V, et al. Diabetes Obes Metab. 2014 May;16(5):403-9. doi: 10.1111/dom.12229. Epub 2013 Dec 2. Diabetes Obes Metab. 2014. PMID: 24199686 Free PMC article. Clinical Trial. - Dipeptidyl peptidase-4 inhibitors for treatment of type 2 diabetes mellitus in the clinical setting: systematic review and meta-analysis.
Karagiannis T, Paschos P, Paletas K, Matthews DR, Tsapas A. Karagiannis T, et al. BMJ. 2012 Mar 12;344:e1369. doi: 10.1136/bmj.e1369. BMJ. 2012. PMID: 22411919
Cited by
- 2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association.
Moon JS, Kang S, Choi JH, Lee KA, Moon JH, Chon S, Kim DJ, Kim HJ, Seo JA, Kim MK, Lim JH, Song YJ, Yang YS, Kim JH, Lee YB, Noh J, Hur KY, Park JS, Rhee SY, Kim HJ, Kim HM, Ko JH, Kim NH, Kim CH, Ahn J, Oh TJ, Kim SK, Kim J, Han E, Jin SM, Bae J, Jeon E, Kim JM, Kang SM, Park JH, Yun JS, Cha BS, Moon MK, Lee BW. Moon JS, et al. Diabetes Metab J. 2024 Jul;48(4):546-708. doi: 10.4093/dmj.2024.0249. Epub 2024 Jul 26. Diabetes Metab J. 2024. PMID: 39091005 Free PMC article. No abstract available. - Two-Year Therapeutic Efficacy and Safety of Initial Triple Combination of Metformin, Sitagliptin, and Empagliflozin in Drug-Naïve Type 2 Diabetes Mellitus Patients.
Park YH, Sohn M, Lee SY, Lim S. Park YH, et al. Diabetes Metab J. 2024 Mar;48(2):253-264. doi: 10.4093/dmj.2023.0128. Epub 2024 Jan 26. Diabetes Metab J. 2024. PMID: 38273791 Free PMC article. - 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2024.
American Diabetes Association Professional Practice Committee. American Diabetes Association Professional Practice Committee. Diabetes Care. 2024 Jan 1;47(Suppl 1):S158-S178. doi: 10.2337/dc24-S009. Diabetes Care. 2024. PMID: 38078590 Review. - Efficacy and Safety of Evogliptin Add-on Therapy to Dapagliflozin/Metformin Combinations in Patients with Poorly Controlled Type 2 Diabetes Mellitus: A 24-Week Multicenter Randomized Placebo-Controlled Parallel-Design Phase-3 Trial with a 28-Week Extension.
Moon JS, Park IR, Kim HJ, Chung CH, Won KC, Han KA, Park CY, Won JC, Kim DJ, Koh GP, Kim ES, Yu JM, Hong EG, Lee CB, Yoon KH. Moon JS, et al. Diabetes Metab J. 2023 Nov;47(6):808-817. doi: 10.4093/dmj.2022.0387. Epub 2023 Sep 26. Diabetes Metab J. 2023. PMID: 37750183 Free PMC article. Clinical Trial. - Glycaemic Control and Weight Reduction: A Narrative Review of New Therapies for Type 2 Diabetes.
Vázquez LA, Romera I, Rubio-de Santos M, Escalada J. Vázquez LA, et al. Diabetes Ther. 2023 Nov;14(11):1771-1784. doi: 10.1007/s13300-023-01467-5. Epub 2023 Sep 15. Diabetes Ther. 2023. PMID: 37713104 Free PMC article. Review.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous