No superior third drug for hyperglycaemia

NO ANTIHYPERGLYCAEMIC drug class is superior to any other when added as a third agent in patients with type 2 diabetes, a meta-analysis shows.

Brazilian researchers looked at the efficacy of add-on anti­hyperglycaemic agents in patients not controlled on metformin and sulphonylurea, analysing 18 trials involving 4500 patients.

They found that HbA1c was reduced by 0.9% when a third agent was added, but it didn’t matter if it was insulin, thiazolidinediones, acarbose, glucagon-like peptide-1 (GLP-1) agonists or DPP-4 inhibitors.

Acarbose resulted in the lowest decrease in HbA1c at 0.7% and insulin caused the greatest decrease in HbA1c at 1.08%.

However, insulin caused a 2.8 kg increase in weight, and thiazolidinediones a 4.3 kg increase, compared with a 1.6 kg weight loss with GLP-1 agonists.

Insulin also caused around twice as many severe hypoglycaemic incidences as the other agents.

“When choosing a