DSEN Abstract
New Drugs for Type 2 Diabetes: A Systematic Review and Network Meta-Analysis of Efficacy and Safety

Key messages

This systematic review updates several previous evidence reviews completed by the Canadian Agency for Drugs and Technologies in Health.
For adults with type 2 diabetes without established cardiovascular disease, adding a sulfonylurea drug to existing metformin is not enough to control blood glucose levels.
For adults with type 2 diabetes with established cardiovascular disease, more study data are required.
Individualized risk assessments should be made to determine ideal second line therapy.

Authors: SE Kelly, A Johnston, S Hsieh, K Elliott, Z Bai, A Hossain, L Chen, GA Wells

For more information, please contact:
George A. Wells
gawells@ottawaheart.ca

Pharmacologic treatment of type 2 diabetes following the failure of conventional diet and exercise interventions begins with metformin (except where contraindicated). Inadequate glycemic control with metformin is common.
Treatment algorithms recommend the addition of oral or injectable antidiabetic drugs or insulin to metformin as a next step (second-line therapy).
There is a need to reassess the comparative efficacy and safety of the available drug classes for second line treatment of patients with type 2 diabetes.

The objective of this review is to update a previous systematic review and network meta-analyses and provide clinical data to inform cost-effectiveness analysis of second-line therapies for type 2 diabetes.
The scope considered the most commonly prescribed second-line treatments as drugs classes including: sulfonylureas, insulins, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) analogues and sodium-glucose cotransporter-2 (SGLT-2) inhibitors.

A systematic review was conducted according to a predefined protocol (PROSPERO CRD42016038144). Data available up to June 2016 were examined using network meta-analysis.
A total of 37 outcomes were considered, including glycated hemoglobin (A1C), weight, blood pressure, cholesterol, overall or severe hypoglycemia and important long-term cardiovascular outcomes.

One-hundred and seventy-five trials were included in this review.
All the drugs reviewed worked well for treating diabetes in that they all similarly reduced A1C when added to metformin. No one drug class showed any clear superiority in efficacy or safety outcomes. Certain drugs may help protect patients with type 2 diabetes and established cardiovascular disease but there is limited evidence to consider at this time.
Full results are available in the published report. Information is current to May 2017.

CADTH/CDA report: Drugs for Type 2 Diabetes: Second-Line Therapy Review Update