7. Approaches to Glycemic Treatment

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doi:10.2337/dc15-s010

Cited by 179 publications

(87 citation statements)

References 35 publications

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“…29 The 2015 American Diabetes Association (ADA) position statement expresses no preference amongst SUs, pioglitazone, flozins and gliptins in people who cannot take metformin. 30 If SUs were the same price as the newer drugs such as the gliptins or the flozins, they would probably be superceded. But they are very cheap, and have been used for so long that all their AEs are known.…”

Section: Sulfonylureasmentioning

confidence: 99%

Canagliflozin, dapagliflozin and empagliflozin monotherapy for treating type 2 diabetes: systematic review and economic evaluation

Johnston

Uthman

Cummins

et al. 2017

Health Technol Assess

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Background Most people with type 2 diabetes are overweight, so initial treatment is aimed at reducing weight and increasing physical activity. Even modest weight loss can improve control of blood glucose. If drug treatment is necessary, the drug of first choice is metformin. However, some people cannot tolerate metformin, which causes diarrhoea in about 10%, and it cannot be used in people with renal impairment. This review appraises three of the newest class of drugs for monotherapy when metformin cannot be used, the sodium–glucose co-transporter 2 (SGLT2) inhibitors. Objective To review the clinical effectiveness and cost-effectiveness of dapagliflozin (Farxiga, Bristol-Myers Squibb, Luton, UK), canagliflozin (Invokana, Janssen, High Wycombe, UK) and empagliflozin (Jardiance, Boehringer Ingelheim, Ingelheim, Germany/Eli Lilly and Company, Indianapolis, IN, USA), in monotherapy in people who cannot take metformin. Sources MEDLINE (1946 to February 2015) and EMBASE (1974 to February 2015) for randomised controlled trials lasting 24 weeks or more. For adverse events, a wider range of studies was used. Three manufacturers provided submissions. Methods Systematic review and economic evaluation. A network meta-analysis was carried out involving the three SGLT2 inhibitors and key comparators. Critical appraisal of submissions from three manufacturers. Results We included three trials of dapagliflozin and two each for canagliflozin and empagliflozin. The trials were of good quality. The canagliflozin and dapagliflozin trials compared them with placebo, but the two empagliflozin trials included active comparators. All three drugs were shown to be effective in improving glycaemic control, promoting weight loss and lowering blood pressure (BP). Limitations There were no head-to-head trials of the different flozins, and no long-term data on cardiovascular outcomes in this group of patients. Most trials were against placebo. The trials were done in patient groups that were not always comparable, for example in baseline glycated haemoglobin or body mass index. Data on elderly patients were lacking. Conclusions Dapagliflozin, canagliflozin and empagliflozin are effective in improving glycaemic control, with added benefits of some reductions in BP and weight. Adverse effects are urinary and genital tract infections in a small proportion of users. In monotherapy, the three drugs do not appear cost-effective compared with gliclazide or pioglitazone, but may be competitive against sitagliptin (Januvia, Merck Sharp & Dohme Limited, Kenilworth, NJ, USA). Funding The National Institute for Health Research Health Technology Assessment programme.

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Section: Sulfonylureasmentioning

confidence: 99%

Canagliflozin, dapagliflozin and empagliflozin monotherapy for treating type 2 diabetes: systematic review and economic evaluation

Johnston

Uthman

Cummins

et al. 2017

Health Technol Assess

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“…Sodium glucose cotransporter 2 (SGLT2) inhibitors are a novel class of drugs that treat T2DM through an insulin-independent mechcently included in the American Diabetes Association (ADA) Standards of Medical Care as an additional treatment option for T2DM to be used as second-or third-line therapy. 19 SGLT2 inhibitors have been shown to improve glycemic control, reduce body weight (BW), and lower systolic blood pressure (SBP), with a low risk of hypoglycemia when used alone or combined with antihyperglycemic therapies not associated with hypoglycemia. 16 Our analysis evaluated the efficacy and safety of the SGLT2 inhibitor canagliflozin in Hispanic/ Latino patients with T2DM, one of the larger populations with T2DM.…”

Section: Americanmentioning

confidence: 99%

Efficacy and Safety of Canagliflozin in Patients With Type 2 Diabetes Mellitus of Different Ethnicity

Davidson

Aguilar²,

González

et al. 2016

Ethn Dis

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Objective: To assess the efficacy and safety of the sodium glucose co-transporter 2 (SGLT2) inhibitor canagliflozin in patients of different ethnicities.Design, Setting, and Patients: Post hoc analysis of data pooled from four randomized, placebo-controlled, phase 3 studies of adults with inadequately controlled type 2 diabetes mellitus (T2DM).Interventions: Once daily oral canagliflozin 100 mg or 300 mg, or placebo. Main Outcome Measures:Efficacy endpoints included change from baseline in HbA1c, body weight (BW), systolic blood pressure (SBP), and lipids at week 26; safety and tolerability were assessed by adverse event reports.Results: Of the 2,313 patients included in this pooled analysis, 609 self-identified as Hispanic/Latino. Hispanic/Latino patients had a mean age of 54 years, mean duration of T2DM of 7 years, mean HbA1c of 8.1%, mean body mass index of 31.2 kg/m 2 , and mean SBP of 126.1 mm Hg. There were more women in the non-Hispanic/Latino cohort (63%) compared with the Hispanic/ Latino cohort. Placebo-subtracted changes in HbA1c were −.82% with canagliflozin 100 mg and −.94% with canagliflozin 300 mg in the Hispanic/Latino cohort, which were similar to reductions observed in the non-Hispanic/Latino cohort. Significantly greater dose-related reductions in HbA1c, BW, and SBP were observed with both canagliflozin doses compared with placebo. Canagliflozin was generally well-tolerated. Genital mycotic infections were less frequent in Hispanic/Latino women than in non-Hispanic/Latino women. Conclusions:The SGLT2 inhibitor canagliflozin was generally well-tolerated and

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“…С учетом особенностей механизма действия могут сочетаться со всеми основными классами сахаросни-жающих препаратов, что отражено в обновленных ре-комендательных документах по лечению СД2 ведущих международных профессиональных ассоциаций (однако комбинация иНГЛТ-2 и аГПП-1 остается неизучен-ной) [4,23]. В клинических исследованиях использование иНГЛТ-2 в комбинации с инсулином сопровождалось снижением дозы последнего [24].…”

“…[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] контроля гликемии, достижение этих целей назначением монотерапии не представляется возможным. В этой ситуации сразу с момента диагностики СД2 наиболее целесообразным является назначение комбинации 2 са-хароснижающих препаратов, воздействующих на разные механизмы развития болезни.…”

Section: изменение образа жизниunclassified

Initiation and intensification of antihyperglycemic therapy in type 2 diabetes mellitus: Update of Russian Association of Endocrinologists expert consensus document (2015)

et al. 2015

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7. Approaches to Glycemic Treatment

Cited by 179 publications

References 35 publications

Canagliflozin, dapagliflozin and empagliflozin monotherapy for treating type 2 diabetes: systematic review and economic evaluation

Canagliflozin, dapagliflozin and empagliflozin monotherapy for treating type 2 diabetes: systematic review and economic evaluation

Efficacy and Safety of Canagliflozin in Patients With Type 2 Diabetes Mellitus of Different Ethnicity

Initiation and intensification of antihyperglycemic therapy in type 2 diabetes mellitus: Update of Russian Association of Endocrinologists expert consensus document (2015)

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