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Abd El Aziz, Mirna S.; Kahle, Melanie; Meier, Juris J.; Nauck, Michael A.

A meta‐analysis comparing clinical effects of short‐ or long‐acting GLP‐1 receptor agonists versus insulin treatment from head‐to‐head studies in type 2 diabetic patients

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  • Medientyp: E-Artikel
  • Titel: A meta‐analysis comparing clinical effects of short‐ or long‐acting GLP‐1 receptor agonists versus insulin treatment from head‐to‐head studies in type 2 diabetic patients
  • Beteiligte: Abd El Aziz, Mirna S.; Kahle, Melanie; Meier, Juris J.; Nauck, Michael A.
  • Erschienen: Wiley, 2017
  • Erschienen in: Diabetes, Obesity and Metabolism, 19 (2017) 2, Seite 216-227
  • Sprache: Englisch
  • DOI: 10.1111/dom.12804
  • ISSN: 1462-8902; 1463-1326
  • Entstehung:
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  • Beschreibung: <jats:sec><jats:title>Aims</jats:title><jats:p>To study differences in clinical outcomes between initiating glucagon‐like peptide‐1 receptor agonist (<jats:styled-content style="fixed-case">GLP</jats:styled-content>‐1 <jats:styled-content style="fixed-case">RAs</jats:styled-content>) vs insulin treatment in patients with type 2 diabetes treated with oral glucose‐lowering medications (<jats:styled-content style="fixed-case">OGLM</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Prospective, randomized trials comparing <jats:styled-content style="fixed-case">GLP</jats:styled-content>‐1 <jats:styled-content style="fixed-case">RA</jats:styled-content> and insulin treatment head‐to‐head as add‐on to <jats:styled-content style="fixed-case">OGLM</jats:styled-content> were identified (<jats:styled-content style="fixed-case">PubMed</jats:styled-content>). Differences from baseline values were compared for <jats:styled-content style="fixed-case">HbA1c</jats:styled-content>, fasting plasma glucose, bodyweight, blood pressure, heartrate and lipoproteins. Proportions of patients reporting hypoglycaemic episodes were compared.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 712 publications identified, 23 describing 19 clinical trials were included in the meta‐analysis. Compared to insulin, <jats:styled-content style="fixed-case">GLP</jats:styled-content>‐1 <jats:styled-content style="fixed-case">RAs</jats:styled-content> reduced <jats:styled-content style="fixed-case">HbA1c</jats:styled-content> more effectively (Δ −.12%, <jats:italic> P </jats:italic> &lt; .0001). Basal insulin was more effective in reducing fasting plasma glucose (Δ −1.8 mmol/L, <jats:italic> P </jats:italic> &lt; .0001). <jats:styled-content style="fixed-case">GLP</jats:styled-content>‐1 <jats:styled-content style="fixed-case">RAs</jats:styled-content> reduced bodyweight more effectively (Δ −3.71 kg; <jats:italic> P </jats:italic> &lt; .0001). The proportion of patients experiencing hypoglycaemic episodes was 34% lower with <jats:styled-content style="fixed-case">GLP</jats:styled-content>‐1 <jats:styled-content style="fixed-case">RAs</jats:styled-content> (<jats:italic> P </jats:italic> &lt; .0001), with a similar trend for severe hypoglycaemia. Systolic blood pressure was lower and heartrate was higher with <jats:styled-content style="fixed-case">GLP</jats:styled-content>‐1 <jats:styled-content style="fixed-case">RAs</jats:styled-content> (<jats:italic> P </jats:italic> &lt; .0001). Triglycerides and <jats:styled-content style="fixed-case">LDL</jats:styled-content> cholesterol were significantly lower with <jats:styled-content style="fixed-case">GLP</jats:styled-content>‐1 <jats:styled-content style="fixed-case">RAs</jats:styled-content>. Long‐acting <jats:styled-content style="fixed-case">GLP</jats:styled-content>‐1 <jats:styled-content style="fixed-case">RAs</jats:styled-content> were better than short‐acting <jats:styled-content style="fixed-case">GLP</jats:styled-content>‐1 <jats:styled-content style="fixed-case">RAs</jats:styled-content> in reducing <jats:styled-content style="fixed-case">HbA1c</jats:styled-content> and fasting glucose, but were similar regarding bodyweight.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Slightly better glycaemic control can be achieved by adding <jats:styled-content style="fixed-case">GLP</jats:styled-content>‐1 <jats:styled-content style="fixed-case">RAs</jats:styled-content> to <jats:styled-content style="fixed-case">OGLM</jats:styled-content> as compared to insulin treatment, with added benefits regarding bodyweight, hypoglycaemia, blood pressure and lipoproteins. These differences are in contrast to the fact that insulin is prescribed far more often than <jats:styled-content style="fixed-case">GLP</jats:styled-content>‐1 <jats:styled-content style="fixed-case">RAs</jats:styled-content>.</jats:p></jats:sec>