In a new study, researchers did a comparison of glucose-lowering drugs and found that metformin-based therapy should be the first-line treatment for people with type 2 diabetes at low heart risk.
There is not enough evidence to reach a conclusion about the optimal initial treatment of patients at increased heart risk.
The research was conducted by a team from Aristotle University of Thessaloniki in Greece.
Increasing evidence shows that anti-diabetic drug classes differ not only in glycemic efficacy but also in their effect on mortality and vascular health.
This means that doctors must base their treatment decisions on more than glycemic control.
They must also consider individual patient characteristics, such as a history of atherosclerotic disease, heart failure, or chronic kidney disease.
In the study, the team did a network meta-analysis that presents the most up-to-date and comprehensive evidence map of the treatment of type 2 diabetes.
They reviewed 453 trials assessing 21 anti-diabetic interventions from 9 drug classes to compare the benefits and harms of glucose-lowering drugs in adults with type 2 diabetes.
The design and rationale of the study were informed by patients’ input regarding their views and concerns about the management of type 2 diabetes and its impact on their lives.
Interventions included monotherapies, an add-on to metformin-based therapies, and monotherapies versus add-on to metformin therapies.
Based on the data, the researchers found no differences between treatments in patients at low heart risk.
Insulin regimens and specific glucagon-like peptide-1 receptor agonists (GLP-1 RAs) added to metformin-based background therapy produced the greatest reductions in hemoglobin A1c level.
For patients at increased heart risk receiving metformin-based background therapy, specific GLP-1 RAs and sodium-glucose cotransporter-2 (SGLT-2) inhibitors had a favorable effect on certain heart outcomes.
These conclusions build on the latest treatment recommendations of international scientific organizations by documenting the heart effects of all available anti-diabetic medications and by highlighting differences, not only between drug classes but also between drugs of the same class.
The study is published in the Annals of Internal Medicine.
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