Comparison of Effects of Gliclazide, Metformin and Pioglitazone Monotherapies on Glycemic Control and Cardiovascular Risk Factors in Patients with Newly Diagnosed Uncontrolled Type 2 Diabetes Mellitus

Erem, Cihangir; Özbaş, Hasan Mücahit; Nuhoğlu, İrfan; Civan, Nadim; Ersöz, Halil Önder

doi:10.1055/s-0034-1370989

Cited by 35 publications

(20 citation statements)

References 34 publications

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“…It contains eight trials but the others are smaller and carry less weight. Apart from the Erem trial, 158 their HbA 1c results in the other five are as expected from sulfonylureas, showing reductions ranging from 0.6% to 1.8%.…”

Section: Clinical Effectiveness Aspects Of the Submissions From The Mmentioning

confidence: 80%

“…This is Erem 2014, 158 which was used in the AG NMA. The AstraZeneca forest plot reports a reduction in HbA 1c of 0.14% compared with placebo.…”

Section: Clinical Effectiveness Aspects Of the Submissions From The Mmentioning

confidence: 99%

“…The AstraZeneca forest plot reports a reduction in HbA 1c of 0.14% compared with placebo. There was no placebo group in Erem 2014 158 which compared gliclazide with pioglitazone and metformin. The HbA 1c was reduced from 8.26% at baseline in the gliclazide group to 6.92% at 6 months, so a more credible reduction against placebo might have been to use the 1.34% before-and-after figure.…”

Section: Clinical Effectiveness Aspects Of the Submissions From The Mmentioning

confidence: 99%

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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: Clinical Effectiveness Aspects Of the Submissions From The Mmentioning

confidence: 80%

“…This is Erem 2014, 158 which was used in the AG NMA. The AstraZeneca forest plot reports a reduction in HbA 1c of 0.14% compared with placebo.…”

Section: Clinical Effectiveness Aspects Of the Submissions From The Mmentioning

confidence: 99%

Section: Clinical Effectiveness Aspects Of the Submissions From The Mmentioning

confidence: 99%

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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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“…Our literature search identified 4,021 articles, of which 12 RCTs (1,050 subjects) complied with the inclusion criteria and were therefore included in the meta-analysis (Figure 1) [18][19][20][21][22][23][24][25][26][27][28][29]. Table 1 shows the characteristics of the 12 trials, and Figure 2 shows the network map.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

Effects of sulfonylurea treatment on blood plasminogen activator inhibitor-1 levels in patients with type 2 diabetes mellitus: A network meta-analysis

Ida¹,

Murata²,

Kaneko³

2018

J Diab Res Clin Met

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Background: To compare the effects ofthree types of sulfonylureas (glibenclamide, gliclazide, and glimepiride) on blood plasminogen activator inhibitor-1 levels in patients with type2 diabetes mellitus, a network meta-analysis of randomized controlled trialswas performed. Methods: A literature search using MEDLINE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov was conducted. Randomized controlled trialsin which the effects of sulfonylureas on blood plasminogen activator inhibitor-1 levels in patients with type 2 diabetes mellitus were evaluated were includes. Outcome assessment included standardized mean differences and 95% confidence intervals. Results: Twelve randomized controlled trials (1,050 subjects) met the inclusion criteria and were included in the network meta-analysis. No significant difference was observedin blood plasminogen activator inhibitor-1 levels after using a placebo compared with those after using glibenclamide, gliclazide, and glimepiride. Blood plasminogen activator inhibitor-1levels were significantly lower after using gliclazide than after using glimepiride (standardized mean difference: -0.52; 95% confidence interval: -0.99%-0.44%). However, no significant difference was observed in blood plasminogen activator inhibitor-1 levels after using glibenclamide compared with those after using gliclazide and glime piride. Conclusions: Regarding the use of sulfonylureas for treating patients with type 2 diabetes mellitus, gliclazide may be preferable because of low blood plasminogen activator inhibitor-1 levels after its use. However, few studies have been published on the use of gliclazide, and the quality of these studies has been generally poor; thus, the results of this study should be interpreted with caution.

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“…The procedures of random sequence generation in seven studies [26,27,31,33,[35][36][37], of allocation concealment in nine studies [26][27][28]31,[33][34][35][36][37], and of blinding of participants and personnel in five studies [30,[32][33][34]36] were not clearly described. Selective reporting risk was unclear in one study [32].…”

Section: Quality Assessmentmentioning

confidence: 99%

Metformin Treatment and Homocysteine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Zhang

et al. 2016

Value in Health

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Abstract:The aim of this systematic review is to assess whether metformin could change the concentration of serum homocysteine (Hcy) with and without simultaneous supplementation of B-group vitamins or folic acid. A literature search was conducted in PubMed, EmBase, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials (RCTs) reporting the concentration of serum Hcy in metformin-treated adults. Meta-analysis was applied to assess the association between metformin and the changes of Hcy concentration. Twelve publications were included in this study. In the overall analysis, metformin administration was not statistically associated with the change of Hcy when compared with the control treatment (mean difference (MD), 0.40 µmol/L; 95% confidence interval (CI), −0.07~0.87 µmol/L, p = 0.10). In the subgroup analysis, metformin was significantly associated with an increased concentration of Hcy in the absence of exogenous supplementation of folic acid or B-group vitamins (MD, 2.02 µmol/L; 95% CI, 1.37~2.67 µmol/L, p < 0.00001), but with a decreased concentration of serum Hcy in the presence of these exogenous supplementations (MD, −0.74 µmol/L; 95% CI, −1.19~−0.30 µmol/L, p = 0.001). Therefore, although the overall effect of metformin on the concentration of serum Hcy was neutral, our results suggested that metformin could increase the concentration of Hcy when exogenous B-group vitamins or folic acid supplementation was not given.

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Comparison of Effects of Gliclazide, Metformin and Pioglitazone Monotherapies on Glycemic Control and Cardiovascular Risk Factors in Patients with Newly Diagnosed Uncontrolled Type 2 Diabetes Mellitus

Cited by 35 publications

References 34 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

Effects of sulfonylurea treatment on blood plasminogen activator inhibitor-1 levels in patients with type 2 diabetes mellitus: A network meta-analysis

Metformin Treatment and Homocysteine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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