| Glucagon-like peptide-1 receptor agonists (GLP-1 RA) versus insulin in inadequately controlled patients with type 2 diabetes mellitus: a meta-analysis of clinical trials. | |
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MedLine Citation:
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PMID: 21651690 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Aims To compare the effect and safety of GLP-1 receptor agonists (GLP-1 RA) with insulin therapy on type 2 diabetes mellitus (T2DM) patients inadequately controlled with metformin (MET) and/or sulfonylurea (SU). Methods A systematic literature search on Medline, Embase and Cochrane for randomized controlled trials (RCTs) was conducted using specific search terms "GLP-1 insulin type2 diabetes clinical trials" and 8 eligible studies were retrieved. Data on mean change in Haemoglobin A1c (HbA1C), weight loss, fasting plasma glucose (FPG), incidence of hypoglycemia and gastrointestinal adverse events were extracted from each study and pooled in meta-analysis. Data on postprandial plasma glucose (PPG) and adverse events were also described or tabulated. Results Data from 8 RCTs enrolling 2782 patients were pooled using a random-effects model. The mean net change(95% confidence interval(CIs)) for HbA1c, weight loss and FPG for patients treated with GLP-1 RA as compared with insulin was -0.14% (-2mmol/mol)[(-0.27, -0.02)%; 95%CI; P=0.03]; -4.40kg [(-5.23,-3.56)kg; 95%CI; P<0.01]; 1.18mmol/l[(0.43, 1.93) mmol/l; 95%CI; P<0.01], respectively, with negative values favoring GLP-1 and positive values favoring insulin. The GLP-1 group was associated with a greater reduction in PPG than the insulin group. Overall, hypoglycemia was reported less in the GLP-1 group (M-H OR 0.45[0.27, 0.76]; P<0.01) while there was no significant difference in occurrence of severe hypoglycemia (M-H OR 0.65 [0.29,1.45]; P=0.29). A significantly higher number of gastrointestinal adverse events were reported with GLP-1 group (M-H OR 15.00 [5.44,41.35] P<0.01). Conclusions GLP-1 RA are promising new agents compared with insulin. Further prospective clinical trials are expected to fully evaluate the long-term effectiveness and safety of these therapies within the T2DM treatment paradigm. |
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Authors:
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Yisu Wang; Ling Li; Mengliu Yang; Hua Liu; Guenther Boden; Gangyi Yang |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-6-8 |
Journal Detail:
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Title: Diabetes, obesity & metabolism Volume: - ISSN: 1463-1326 ISO Abbreviation: - Publication Date: 2011 Jun |
Date Detail:
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Created Date: 2011-6-9 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100883645 Medline TA: Diabetes Obes Metab Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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© 2011 Blackwell Publishing Ltd. |
Affiliation:
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Department of Endocrinology, the Second Affiliated Hospital, Chongqing Medical University, 400010 Chongqing, China The Key Laboratory of Laboratory Medical Diagnostics in the Ministry of Education and Department of Clinical Biochemistry, Chongqing Medical University, 400016 Chongqing, China Department of Pediatrics, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi, MS 39216-4505, USA The Division of Endocrinology/Diabetes/Metabolism and the Clinical Research Center, Temple University School of Medicine, Philadelphia, Pennsylvania, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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