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/37024129, Uniform Resource Identifier (URI)/urn:oid:2.16.840.1.113883.4.642.40.44.15.11
version: 2.0.0-ballot
title: 37024129 Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials.
status: Active
date: 2024-12-19 14:29:51+0000
publisher: HL7 International / Clinical Decision Support
contact: HL7 International / Clinical Decision Support: http://www.hl7.org/Special/committees/dss
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approvalDate: 2023-04-10
lastReviewDate: 2023-04-11
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https://pubmed.ncbi.nlm.nih.gov
/37024129,https://www.ncbi.nlm.nih.gov/pmc/
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/10.1136/bmj-2022-074068Titles
Type Language Text Primary title English Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials.
Abstracts
Text Copyright OBJECTIVE: To compare the benefits and harms of drug treatments for adults with type 2 diabetes, adding non-steroidal mineralocorticoid receptor antagonists (including finerenone) and tirzepatide (a dual glucose dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonist) to previously existing treatment options. <AbstractText Label="DESIGN">Systematic review and network meta-analysis. <AbstractText Label="DATA SOURCES">Ovid Medline, Embase, and Cochrane Central up to 14 October 2022. <AbstractText Label="ELIGIBILITY CRITERIA FOR SELECTING STUDIES">Eligible randomised controlled trials compared drugs of interest in adults with type 2 diabetes. Eligible trials had a follow-up of 24 weeks or longer. Trials systematically comparing combinations of more than one drug treatment class with no drug, subgroup analyses of randomised controlled trials, and non-English language studies were deemed ineligible. Certainty of evidence was assessed following the GRADE (grading of recommendations, assessment, development and evaluation) approach. RESULTS: The analysis identified 816 trials with 471 038 patients, together evaluating 13 different drug classes; all subsequent estimates refer to the comparison with standard treatments. Sodium glucose cotransporter-2 (SGLT-2) inhibitors (odds ratio 0.88, 95% confidence interval 0.83 to 0.94; high certainty) and GLP-1 receptor agonists (0.88, 0.82 to 0.93; high certainty) reduce all cause death; non-steroidal mineralocorticoid receptor antagonists, so far tested only with finerenone in patients with chronic kidney disease, probably reduce mortality (0.89, 0.79 to 1.00; moderate certainty); other drugs may not. The study confirmed the benefits of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing cardiovascular death, non-fatal myocardial infarction, admission to hospital for heart failure, and end stage kidney disease. Finerenone probably reduces admissions to hospital for heart failure and end stage kidney disease, and possibly cardiovascular death. Only GLP-1 receptor agonists reduce non-fatal stroke; SGLT-2 inhibitors are superior to other drugs in reducing end stage kidney disease. GLP-1 receptor agonists and probably SGLT-2 inhibitors and tirzepatide improve quality of life. Reported harms were largely specific to drug class (eg, genital infections with SGLT-2 inhibitors, severe gastrointestinal adverse events with tirzepatide and GLP-1 receptor agonists, hyperkalaemia leading to admission to hospital with finerenone). Tirzepatide probably results in the largest reduction in body weight (mean difference -8.57 kg; moderate certainty). Basal insulin (mean difference 2.15 kg; moderate certainty) and thiazolidinediones (mean difference 2.81 kg; moderate certainty) probably result in the largest increases in body weight. Absolute benefits of SGLT-2 inhibitors, GLP-1 receptor agonists, and finerenone vary in people with type 2 diabetes, depending on baseline risks for cardiovascular and kidney outcomes (https://matchit.magicevidence.org/230125dist-diabetes). CONCLUSIONS: This network meta-analysis extends knowledge beyond confirming the substantial benefits with the use of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing adverse cardiovascular and kidney outcomes and death by adding information on finerenone and tirzepatide. These findings highlight the need for continuous assessment of scientific progress to introduce cutting edge updates in clinical practice guidelines for people with type 2 diabetes. <AbstractText Label="SYSTEMATIC REVIEW REGISTRATION">PROSPERO CRD42022325948.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.
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contributor: Shi Q
forenameInitials: Q
affiliation: Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China.
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contributor: Nong K
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affiliation: Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China.
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contributor: Vandvik PO
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affiliation: Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway.
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contributor: Mao Y
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affiliation: Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
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contributor: Chowdhury SR
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affiliation: Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada.
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contributor: Zhai C
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affiliation: Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China.
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contributor: Gupta S
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affiliation: Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada.
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contributor: Gao Y
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affiliation:
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- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
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contributor: Lima JP
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contributor: Numata K
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affiliation: Department of Emergency Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
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contributor: Qiao Z
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contributor: Fan Q
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contributor: Yang Q
forenameInitials: Q
affiliation: Department of Nephrology, National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
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contributor: Jin Y
forenameInitials: Y
affiliation: Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
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contributor: Ge L
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affiliation: Evidence-Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China.
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contributor: Yang Q
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affiliation: Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China.
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contributor: Zhu H
forenameInitials: H
affiliation: Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.
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contributor: Yang F
forenameInitials: F
affiliation: Department of Endocrinology and Metabolism, Chengdu Fifth People's Hospital, Chengdu, China.
entry
contributor: Chen Z
forenameInitials: Z
affiliation: Evidence-Based Medicine Centre, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
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contributor: Lu X
forenameInitials: X
affiliation: Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China.
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contributor: He S
forenameInitials: S
affiliation: Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
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contributor: Chen X
forenameInitials: X
affiliation: Department of Endocrinology and Metabolism, First People's Hospital of Shuangliu District, Chengdu, China.
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contributor: Lyu X
forenameInitials: X
affiliation: Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
entry
contributor: An X
forenameInitials: X
affiliation: Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China.
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contributor: Chen Y
forenameInitials: Y
affiliation: Evidence-Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China.
entry
contributor: Hao Q
forenameInitials: Q
affiliation: School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
entry
contributor: Standl E
forenameInitials: E
affiliation: Forschergruppe Diabetes eV at the Helmholtz Centre, Munich-Neuherberg, Germany.
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contributor: Siemieniuk R
forenameInitials: R
affiliation: Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada.
entry
contributor: Agoritsas T
forenameInitials: T
affiliation:
- Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada.
- Division of General Internal Medicine, Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.
entry
contributor: Tian H
forenameInitials: H
affiliation: Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China.
entry
contributor: Li S
forenameInitials: S
affiliation: Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China lisheyu@gmail.com.
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identifier: ORCID/0000-0003-4299-5889
name: Qingyang Shi
Generated Narrative: Practitioner #contributor1
name: Kailei Nong
Generated Narrative: Practitioner #contributor2
name: Per Olav Vandvik
Generated Narrative: Practitioner #contributor3
name: Gordon H Guyatt
Generated Narrative: Practitioner #contributor4
name: Oliver Schnell
Generated Narrative: Practitioner #contributor5
name: Lars Rydén
Generated Narrative: Practitioner #contributor6
name: Nikolaus Marx
Generated Narrative: Practitioner #contributor7
name: Frank C Brosius
Generated Narrative: Practitioner #contributor8
name: Reem A Mustafa
Generated Narrative: Practitioner #contributor9
name: Arnav Agarwal
Generated Narrative: Practitioner #contributor10
name: Xinyu Zou
Generated Narrative: Practitioner #contributor11
name: Yunhe Mao
Generated Narrative: Practitioner #contributor12
name: Aminreza Asadollahifar
Generated Narrative: Practitioner #contributor13
name: Saifur Rahman Chowdhury
Generated Narrative: Practitioner #contributor14
name: Chunjuan Zhai
Generated Narrative: Practitioner #contributor15
name: Sana Gupta
Generated Narrative: Practitioner #contributor16
name: Ya Gao
Generated Narrative: Practitioner #contributor17
name: João Pedro Lima
Generated Narrative: Practitioner #contributor18
name: Kenji Numata
Generated Narrative: Practitioner #contributor19
name: Zhi Qiao
Generated Narrative: Practitioner #contributor20
name: Qinlin Fan
Generated Narrative: Practitioner #contributor21
name: Qinbo Yang
Generated Narrative: Practitioner #contributor22
name: Yinghui Jin
Generated Narrative: Practitioner #contributor23
name: Long Ge
Generated Narrative: Practitioner #contributor24
name: Qiuyu Yang
Generated Narrative: Practitioner #contributor25
name: Hongfei Zhu
Generated Narrative: Practitioner #contributor26
name: Fan Yang
Generated Narrative: Practitioner #contributor27
name: Zhe Chen
Generated Narrative: Practitioner #contributor28
name: Xi Lu
Generated Narrative: Practitioner #contributor29
name: Siyu He
Generated Narrative: Practitioner #contributor30
name: Xiangyang Chen
Generated Narrative: Practitioner #contributor31
name: Xiafei Lyu
Generated Narrative: Practitioner #contributor32
name: Xingxing An
Generated Narrative: Practitioner #contributor33
name: Yaolong Chen
Generated Narrative: Practitioner #contributor34
name: Qiukui Hao
Generated Narrative: Practitioner #contributor35
name: Eberhard Standl
Generated Narrative: Practitioner #contributor36
name: Reed Siemieniuk
Generated Narrative: Practitioner #contributor37
name: Thomas Agoritsas
Generated Narrative: Practitioner #contributor38
name: Haoming Tian
Generated Narrative: Practitioner #contributor39
identifier: ORCID/0000-0003-0060-0287
name: Sheyu Li
Generated Narrative: ArtifactAssessment #meshHeading0
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