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Risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: A systematic review and meta‐analysis
OBJECTIVES: For patients with type 2 diabetes, newer antihyperglycaemic agents (AHA), including the dipeptidyl peptidase IV inhibitors (DPP4i), glucagon‐like peptide‐1 receptor agonists (GLP1RA) and sodium glucose co‐transporter 2 inhibitors (SGLT2i) offer a lower risk of hypoglycaemia relative to s...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947712/ https://www.ncbi.nlm.nih.gov/pubmed/31922027 http://dx.doi.org/10.1002/edm2.100 |
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author | Kamalinia, Sanaz Josse, Robert G. Donio, Patrick J. Leduc, Lindsay Shah, Baiju R. Tobe, Sheldon W. |
author_facet | Kamalinia, Sanaz Josse, Robert G. Donio, Patrick J. Leduc, Lindsay Shah, Baiju R. Tobe, Sheldon W. |
author_sort | Kamalinia, Sanaz |
collection | PubMed |
description | OBJECTIVES: For patients with type 2 diabetes, newer antihyperglycaemic agents (AHA), including the dipeptidyl peptidase IV inhibitors (DPP4i), glucagon‐like peptide‐1 receptor agonists (GLP1RA) and sodium glucose co‐transporter 2 inhibitors (SGLT2i) offer a lower risk of hypoglycaemia relative to sulfonylurea or insulin. However, it is not clear how AHA compare to placebo on risk of any hypoglycaemia. This study evaluates the risk of any and severe hypoglycaemia with AHA and metformin relative to placebo. DESIGN: A systematic review and meta‐analysis was conducted of randomized, placebo‐controlled trials ≥12 weeks in duration. MEDLINE, Embase and the Cochrane Library were searched up to April 16, 2019. Studies allowing use of other diabetes medications were excluded. Mantel‐Haenszel risk ratio with 95% confidence intervals were used to pool estimates based on class of AHA and number of concomitant therapies used. PATIENTS: Eligible studies enrolled patients with type 2 diabetes ≥18 years of age. RESULTS: 144 studies met our inclusion criteria. Any hypoglycaemia was not increased with AHA when used as monotherapy (DPP4i (RR 1.12; 95% CI 0.81‐1.56), GLP1RA (1.77; 0.91‐3.46), SGLT2i (1.34; 0.83‐2.15)), or as add‐on to metformin (DPP4i (0.95; 0.67‐1.35), GLP1RA (1.24; 0.80‐1.91), SGLT2i (1.29; 0.91‐1.83)) or as triple therapy (1.13; 0.67‐1.91). However, metformin monotherapy (1.73; 1.02‐2.94) and dual therapy initiation (3.56; 1.79‐7.10) was associated with an increased risk of any hypoglycaemia. Severe hypoglycaemia was rare not increased for any comparisons. CONCLUSIONS: Metformin and the simultaneous initiation of dual therapy, but not AHA used alone or as single add‐on combination therapy, was associated with an increased risk of any hypoglycaemia relative to placebo. |
format | Online Article Text |
id | pubmed-6947712 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-69477122020-01-09 Risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: A systematic review and meta‐analysis Kamalinia, Sanaz Josse, Robert G. Donio, Patrick J. Leduc, Lindsay Shah, Baiju R. Tobe, Sheldon W. Endocrinol Diabetes Metab Original Articles OBJECTIVES: For patients with type 2 diabetes, newer antihyperglycaemic agents (AHA), including the dipeptidyl peptidase IV inhibitors (DPP4i), glucagon‐like peptide‐1 receptor agonists (GLP1RA) and sodium glucose co‐transporter 2 inhibitors (SGLT2i) offer a lower risk of hypoglycaemia relative to sulfonylurea or insulin. However, it is not clear how AHA compare to placebo on risk of any hypoglycaemia. This study evaluates the risk of any and severe hypoglycaemia with AHA and metformin relative to placebo. DESIGN: A systematic review and meta‐analysis was conducted of randomized, placebo‐controlled trials ≥12 weeks in duration. MEDLINE, Embase and the Cochrane Library were searched up to April 16, 2019. Studies allowing use of other diabetes medications were excluded. Mantel‐Haenszel risk ratio with 95% confidence intervals were used to pool estimates based on class of AHA and number of concomitant therapies used. PATIENTS: Eligible studies enrolled patients with type 2 diabetes ≥18 years of age. RESULTS: 144 studies met our inclusion criteria. Any hypoglycaemia was not increased with AHA when used as monotherapy (DPP4i (RR 1.12; 95% CI 0.81‐1.56), GLP1RA (1.77; 0.91‐3.46), SGLT2i (1.34; 0.83‐2.15)), or as add‐on to metformin (DPP4i (0.95; 0.67‐1.35), GLP1RA (1.24; 0.80‐1.91), SGLT2i (1.29; 0.91‐1.83)) or as triple therapy (1.13; 0.67‐1.91). However, metformin monotherapy (1.73; 1.02‐2.94) and dual therapy initiation (3.56; 1.79‐7.10) was associated with an increased risk of any hypoglycaemia. Severe hypoglycaemia was rare not increased for any comparisons. CONCLUSIONS: Metformin and the simultaneous initiation of dual therapy, but not AHA used alone or as single add‐on combination therapy, was associated with an increased risk of any hypoglycaemia relative to placebo. John Wiley and Sons Inc. 2019-11-13 /pmc/articles/PMC6947712/ /pubmed/31922027 http://dx.doi.org/10.1002/edm2.100 Text en © 2019 The Authors. Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Kamalinia, Sanaz Josse, Robert G. Donio, Patrick J. Leduc, Lindsay Shah, Baiju R. Tobe, Sheldon W. Risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: A systematic review and meta‐analysis |
title | Risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: A systematic review and meta‐analysis |
title_full | Risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: A systematic review and meta‐analysis |
title_fullStr | Risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: A systematic review and meta‐analysis |
title_full_unstemmed | Risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: A systematic review and meta‐analysis |
title_short | Risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: A systematic review and meta‐analysis |
title_sort | risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: a systematic review and meta‐analysis |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947712/ https://www.ncbi.nlm.nih.gov/pubmed/31922027 http://dx.doi.org/10.1002/edm2.100 |
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