AI Article Synopsis
- GLP-1 receptor agonists (GLP-1 RAs) have been approved since 2005 as treatment options for type 2 diabetes, alongside basal insulins, making a comprehensive comparison essential for informed treatment decisions.
- A systematic review and meta-analysis were conducted, involving randomized clinical trials that compared GLP-1 RAs with basal insulins in adults inadequately controlled with oral medications, focusing on changes in HbA1c and weight, as well as hypoglycemia incidence.
- The analysis revealed that once-weekly GLP-1 RAs (exenatide LAR and dulaglutide) significantly reduced HbA1c levels while all GLP-1 RAs resulted in weight loss;
Article Abstract
Aims: Since 2005, several glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been approved to treat people with type 2 diabetes. These agents are considered for use at the same point in the treatment paradigm as basal insulins. A comprehensive comparison of these drug classes, therefore, can help inform treatment decisions. This systematic review and meta-analysis assessed the clinical efficacy and safety of GLP-1 RAs compared with basal insulins.
Materials And Methods: MEDLINE, EMBASE, CENTRAL and PubMed databases were searched. Randomized clinical trials (RCTs) of ≥16 weeks' duration comparing GLP-1 RAs vs basal insulins in adults with type 2 diabetes inadequately controlled with oral antihyperglycemic drugs were included. Data on the change from baseline to 26 weeks (±10 weeks) of treatment in hemoglobin A1c (HbA1c) and weight, as well as the proportion of patients experiencing hypoglycaemia, were extracted. Fixed-effect pairwise meta-analyses were conducted where data were available from ≥2 studies.
Results: Fifteen RCTs were identified and 11 were meta-analysed. The once-weekly GLP-1 RAs, exenatide long acting release (LAR) and dulaglutide, led to greater, statistically significant mean HbA1c reductions vs basal insulins (exenatide: -0.31% [95% confidence interval -0.42, -0.19], dulaglutide: -0.39% [-0.49, -0.29]) whilst once-daily liraglutide and twice-daily exenatide did not (liraglutide: 0.06% [-0.06, 0.18], exenatide: 0.01% [-0.11, 0.13]). Mean weight reduction was seen with all GLP-1 RAs while mean weight gain was seen with basal insulins. Interpretation of the analysis of hypoglycaemia was limited by inconsistent definitions and reporting. Because of the limited number of available studies sensitivity analyses to explore heterogeneity could not be conducted.
Conclusions: Although weight reduction is seen with all GLP-1 RA's, only the once-weekly agents, exenatide LAR and dulaglutide, demonstrate significant HbA1c reductions when compared to basal insulins.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299485 | PMC |
| http://dx.doi.org/10.1111/dom.12805 | DOI Listing |
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