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