The increasing prevalence of type 2 diabetes has made finding the most effective treatments critical. This study evaluates the effectiveness of three second-line oral treatments added to metformin in individuals with type 2 diabetes.
“We aimed to see how these treatments compare in real-world clinical practice,” said Dr. Patrick Bidulka, one of the leading researchers. The study analyzed data from over 75,000 adults in England between 2015 and 2021.
Metformin Combinations and Results
Three treatment combinations were compared: metformin with sulfonylureas, DPP-4 inhibitors, and SGLT-2 inhibitors. The primary measure of effectiveness was the change in HbA1c levels, a key indicator of blood sugar control.
Dr. Bidulka explains, “Our findings showed that SGLT-2 inhibitors were more effective in lowering HbA1c, BMI, and systolic blood pressure than both sulfonylureas and DPP-4 inhibitors.”
Additional Health Benefits
Beyond glucose control, SGLT-2 inhibitors showed benefits in other important areas. “We observed a reduction in hospital admissions for heart failure among patients on SGLT-2 inhibitors,” said David G. Lugo-Palacios, co-author. The study also reported a lower risk of kidney disease progression when compared with sulfonylureas.
However, for major cardiovascular events, such as heart attacks and strokes, no significant differences were found between the three treatment options.
Long-Term Considerations
The study further highlighted that while SGLT-2 inhibitors were beneficial for heart failure and kidney protection, they were not superior in all measured outcomes. “The decision to prescribe should take into account the broader health profile of the patient, especially in light of these findings,” noted Dr. Anirban Basu, another study contributor.
This large-scale emulation of a target trial offers valuable insights for physicians and helps guide treatment choices for people with type 2 diabetes who need to add a second oral antidiabetic drug to metformin.
Citation:
Bidulka P, Lugo-Palacios DG, Carroll O, et al. Comparative effectiveness of second line oral antidiabetic treatments among people with type 2 diabetes mellitus: emulation of a target trial using routinely collected health data. BMJ. 2024;385. doi:10.1136/bmj-2023-077097
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