| Proportion of patients at HbA1c target <7% with 8 classes of antidiabetic drugs in type 2 diabetes: systematic review of 218 randomized controlled trials with 78 945 patients. | |
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MedLine Citation:
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PMID: 21958121 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Aim: We assessed the efficacy of 8 classes of diabetes medications used in current clinical practice (metformin, sulfonylureas, α-glucosidase inhibitors, thiazolidinediones, glinides, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 analogs, and insulin analogs) to reach the HbA1c target <7% in type 2 diabetes. Methods: MEDLINE, EMBASE, and the Cochrane CENTRAL were searched from inception through April 2011 for randomized controlled trials (RCTs) involving antidiabetic drugs. RCTs had to report the effect of any diabetes medication on the HbA1c levels, to include at least 30 subjects in every arm of the study, and to report the effect of therapy after a minimum of 12 weeks. Data were summarized across studies using random-effects meta-regression. Results: A total of 218 RCTs (339 arms and 77 950 patients) met the inclusion criteria. The proportion of patients who achieved the HbA1c goal ranged from 25.9% (95% CI 18.5-34.9) with α-glucosidase inhibitors to 63.2% (54.1-71.5) with the long-acting GLP-1 analog. There was a progressive decrease of the proportion of patients at target for each 0.5% increase in baseline HbA1c, ranging from 57.8% for HbA1c ≤7.5% to 20.8% for HbA1c≥10% (P for trend <0.0001), with some difference between insulin and noninsulin drugs: for insulin, the proportion of patients at goal reached a plateau for basal HbA1c value >9.0% with no further decrease, while for noninsulin drugs the relationship was continuous without any evidence of plateau. Conclusions: There is considerable variability with regards to attainment of HbA1c goal of <7% among the different classes of diabetes medications: baseline HbA1c is an important determinant of observed efficacy. |
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Authors:
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K Esposito; P Chiodini; G Bellastella; M I Maiorino; D Giugliano |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-9-29 |
Journal Detail:
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Title: Diabetes, obesity & metabolism Volume: - ISSN: 1463-1326 ISO Abbreviation: - Publication Date: 2011 Sep |
Date Detail:
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Created Date: 2011-9-30 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 Cardio-Thoracic and Respiratory Sciences, Second University of Naples, Naples, Italy Department of Medicine and Public Health, Second University of Naples, Naples, Italy Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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