Effect of Antihyperglycemic Agents Added to Metformin and a Sulfonylurea on Glycemic Control and Weight Gain in Type 2 Diabetes: A Network Meta-analysis

Abstract

Background: Few studies have examined the effect of adding a third antihyperglycemic drug when blood glucose control is not achieved by using metformin and a sulfonylurea.

Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

“…On average, any second agent is typically associated with an approximate further reduction in HbA 1c of ~ 1%. 70,79 If no clinically meaningful glycemic reduction (i.e., "nonresponder") is demonstrated, then, adherence having been investigated, that agent should be discontinued, and another with a different mechanism of action substituted. With a distinct paucity of long-term comparative-effectiveness trials available, uniform recommendations on the best agent to be combined with metformin cannot be made.…”

Efficacy and Safety of the Once-Weekly GLP-1 Receptor Agonist Albiglutide Versus Sitagliptin in Patients With Type 2 Diabetes and Renal Impairment: A Randomized Phase III Study

“…Current treatment options for glycemic control are significantly limited for patients with type 2 diabetes and CKD (5,(8)(9)(10)(11), which often leads to the introduction of sulfonylurea and insulin therapy to maintain glycemic control. Further, therapeutic options for glycemic control can be associated with significant risks of hypoglycemia, weight gain, and fluid retention, which may add to the complexity of maintaining blood glucose, body weight, and blood pressure in this population (12)(13)(14)(15).…”

Type 2 Diabetes Mellitus- Disease, Diagnosis and Treatment

“…In addition, it does not cause weight gain due to its anorexic effect. Weight gain can worsen the course of the disease in the long run [16,17]. Metformin also modestly reduces plasma triglyceride concentrations resulting from decreased production of very low density lipoprotein [18] and has favorable effects on a number of cardiovascular risk factors such as lipids, body weight, blood pressure and platelet function [19,20].…”

“…Another advantage of metformin is the reduction of mortality, as documented in the UKPDS [21]. The most common reported adverse reaction to metformin therapy is gastroin testinal upset including nausea, vomiting, anorexia and diarrhea [17]. Thus, metformin should be started at a low dose at first (500 mg PO bid).…”