Metformin is the recommended initial drug therapy for patients with type 2 diabetes mellitus (DM). However, the optimal second-line drug when metformin monotherapy fails is unclear.
The study followed 11,198 individuals for an average of 32 weeks. Researchers sought to determine the comparative efficacy, risk of weight gain, and hypoyglycemia associated with noninsulin antidiabetic drugs in patients with type 2 DM not controlled by metformin alone. Data used included duration of patient follow-up; drug, dose, and schedule used; use of concurrent lifestyle modification; and baseline characteristics (age, sex, anthropometrics, glycated hemoglobin A1c [HbA1c], duration of DM, and metformin dose). End points collected included mean change in HbA1c, proportion of patients achieving HbA1c goal of less than 7%, change in weight, and incidence of hypoglycemia.
- Although use of thiazolidinediones, sulfonylureas, and glinides were associated with weight gain (range, 1.77-2.08 kg, approximatley 2 to 4 lbs.),
- glucagon-like peptide-1 analogs, -glucosidase inhibitors, and dipeptidyl peptidase-4 inhibitors were associated with weight loss or no weight change.
- Sulfonylureas and glinides were associated with higher rates of hypoglycemia than with placebo.
Researchers conclude that when added to maximal metformin therapy, all noninsulin antidiabetic drugs were associated with similar HbA1c reductions but differed in their associations with weight gain and risk of hypoglycemia.