Metformin first line therapy for diabetes patients at low CVD risk: Meta-analysis

Written By :  Dr. Kamal Kant Kohli
Published On 2020-06-30 07:15 GMT   |   Update On 2020-06-30 09:55 GMT
Advertisement

A comparison of glucose-lowering drugs suggests that metformin-based therapy may be a preferred first-line treatment for drug-naive patients with type 2 diabetes at low cardiovascular risk. There is not enough evidence to reach a conclusion about the optimal initial treatment of drug-naive patients at increased cardiovascular risk. Findings from a systematic review and network meta-analysis are published in Annals of Internal Medicine.

Accumulating evidence shows that antidiabetic drug classes and individual agents differ not only in glycemic efficacy but also in their effect on mortality and vascular end points. This means that clinicians must base their treatment decisions on more than glycemic control. They must also consider individual patient characteristics, such as history of atherosclerotic disease, heart failure, or chronic renal disease. A network meta-analysis that presents the most up-to-date and comprehensive evidence map of the pharmacologic treatment of type 2 diabetes and serves as a bridge between the deluge of clinical research and routine clinical practice.

Researchers from Aristotle University of Thessaloniki in Greece reviewed 453 trials assessing 21 antidiabetic interventions from 9 drug classes to compare benefits and harms of glucose-lowering drugs in adults with type 2 diabetes. The design and rationale of the study were informed by patients' input regarding their views and concerns about the management of the type 2 diabetes and its impact on their lives. Interventions included monotherapies, add-on to metformin-based therapies, and monotherapies versus add-on to metformin therapies. Based on the data, the researchers found 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. For patients at increased cardiovascular risk receiving metformin-based background therapy, specific GLP-1 RAs and sodium–glucose cotransporter-2 (SGLT-2) inhibitors had a favorable effect on certain cardiovascular outcomes.

These conclusions corroborate and build on the latest treatment recommendations of international scientific organizations by documenting the cardiovascular effects of all available antidiabetic medications and by highlighting differences, not only between drug classes, but also between drugs of the same class. Editorialists from the National Institutes of Health discuss the findings and suggest ways that future clinical trials can best inform individualized care for persons with type 2 diabetes.

For further reference log on to:

https://www.acpjournals.org/doi/10.7326/M20-0864

Tags:    
Article Source : Annals of Internal Medicine

Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.

NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.

Our comments section is governed by our Comments Policy . By posting comments at Medical Dialogues you automatically agree with our Comments Policy , Terms And Conditions and Privacy Policy .

Similar News