Incretin mimetics and sodium-glucose co-transporter 2 inhibitors as monotherapy or add-on to metformin for treatment of type 2 diabetes: a systematic review and network meta-analysis

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Shubing Jia 1, Zhiying Wang 1, Ruobing Han 1, Zinv Zhang 1, Yuping Li 1, Xiaotong Qin 1, Mingyi Zhao 1, Rongwu Xiang 2, Jingyu Yang 3 4

Main idea: Both GLP-1RAs and SGLT-2is have their own advantages in efficacy and safety. Monotherapy is beneficial for reducing the risk of hypoglycemia. The recommendation should be a patient-centered approach when selecting treatment choices.

Abstract

Purpose: There are many different methods of treating type 2 diabetes (T2D) It is still difficult to draw coincident conclusions concerning the efficacy and safety of different classes of new drugs. The aim of this study was to summarize evidence on the effectiveness of DPP-4is, GLP-1RAs and SGLT-2

Materials and methods: We searched PubMed, Embase, Cochrane library and ClinicalTrials.gov for relevant articles in keeping with established methods using terms associated with anti-diabetic agents up to February, 2020, with no start date restriction. Weighted mean difference and risk ratios with 95% confidence intervals were calculated within traditional and network meta-analysis. Primary outcomes were the mean change in hemoglobin A1c (HbA1c), fasting plasma glucose (FPG) change and the frequency of hypoglycemic events from baseline after 12 weeks of treatment.

Results: In total, 64 eligible studies comprising 37,780 patients and 7 treatment strategies were included. GLP-1RAs were significantly more effective than DPP-4is or SGLT-2is in reducing HbA1c when add-on to Met. For hypoglycemia, monotherapy has a lower risk than combination therapy except for S GLT- 2is. GLP- 1RAs took the lowest risk to induce the hypoglycemia.

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