Systematic review and meta-analysis of head-to-head trials comparing sulfonylureas and low hypoglycaemic risk antidiabetic drugs.
Adult
Humans
Adolescent
Hypoglycemic Agents
/ adverse effects
Diabetes Mellitus, Type 2
/ complications
Glipizide
/ therapeutic use
Dipeptidyl-Peptidase IV Inhibitors
/ adverse effects
Metformin
/ adverse effects
Sodium-Glucose Transporter 2 Inhibitors
/ therapeutic use
Hypoglycemia
/ chemically induced
Glucagon-Like Peptide 1
Dipeptidyl-Peptidases and Tripeptidyl-Peptidases
/ therapeutic use
Symporters
/ therapeutic use
Glucose
Sodium
All-cause mortality
Diabetes mellitus
Hypoglycemic therapy
MACE
Sulfonylurea
Journal
BMC endocrine disorders
ISSN: 1472-6823
Titre abrégé: BMC Endocr Disord
Pays: England
ID NLM: 101088676
Informations de publication
Date de publication:
19 Oct 2022
19 Oct 2022
Historique:
received:
02
06
2021
accepted:
27
09
2022
entrez:
19
10
2022
pubmed:
20
10
2022
medline:
22
10
2022
Statut:
epublish
Résumé
Safety of sulfonylurea drugs in the treatment of Type 2 Diabetes is still under debate. The aim of this study was to compare the all-cause mortality and cardiovascular adverse events of sulfonylureas and drugs with a low risk for hypoglycaemia in adults with type 2 diabetes. Systematic review and meta-analysis of randomised controlled trials. MEDLINE (PubMed, OVID), Embase, Cochrane Central Register of Controlled Trials, CINAHL, WOS and Lilacs. Randomised controlled head-to-head trials that compared sulfonylureas with active control with low hypoglycaemic potential in adults (≥ 18 years old) with type 2 diabetes published up to August 2015. The drug classes involved in the analysis were metformin, dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium-glucose co-transporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. The primary endpoint was all-cause mortality. The secondary endpoints were MACE, cardiovascular events and severe hypoglycaemia. Two reviewers checked study eligibility, independently extracted data and assessed quality with disagreements resolved through discussion. We assessed the risk of bias of the included studies using the Cochrane risk of bias tool for randomized trials v2. Pooled odds ratios (ORs) were estimated by using fixed effects model. The study is registered on PROSPERO (26/05/2016 CRD42016038780). Our final analysis comprised 31 studies (26,204 patients, 11,711 patients given sulfonylureas and 14,493 given comparator drugs). In comparison to drugs with low hypoglycaemic potential, sulfonylureas had higher odds for all-cause mortality (OR 1.32, 95% CI 1.00-1.75), MACE (OR 1.32, 95% CI 1.07-1.61), myocardial infarction (fatal and non-fatal) (OR 1.67, 95% CI 1.17-2.38) and hypoglycaemia (OR 5.24, 95% CI 4.20-6.55). Subsequent sensitivity analysis revealed differences in the effect of sulfonylureas, with an increased risk of all-cause mortality with glipizide but not the other molecules. Our meta-analysis raises concern about the safety of SUs compared to alternative drugs involved in current analysis. Important differences may exist within the drug class, and glimepiride seems to have best safety profile.
Sections du résumé
BACKGROUND
BACKGROUND
Safety of sulfonylurea drugs in the treatment of Type 2 Diabetes is still under debate. The aim of this study was to compare the all-cause mortality and cardiovascular adverse events of sulfonylureas and drugs with a low risk for hypoglycaemia in adults with type 2 diabetes.
METHODS
METHODS
Systematic review and meta-analysis of randomised controlled trials.
DATA SOURCES
METHODS
MEDLINE (PubMed, OVID), Embase, Cochrane Central Register of Controlled Trials, CINAHL, WOS and Lilacs.
STUDY SELECTION
METHODS
Randomised controlled head-to-head trials that compared sulfonylureas with active control with low hypoglycaemic potential in adults (≥ 18 years old) with type 2 diabetes published up to August 2015. The drug classes involved in the analysis were metformin, dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium-glucose co-transporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists.
OUTCOMES
RESULTS
The primary endpoint was all-cause mortality. The secondary endpoints were MACE, cardiovascular events and severe hypoglycaemia.
SYNTHESIS OF RESULTS
RESULTS
Two reviewers checked study eligibility, independently extracted data and assessed quality with disagreements resolved through discussion. We assessed the risk of bias of the included studies using the Cochrane risk of bias tool for randomized trials v2. Pooled odds ratios (ORs) were estimated by using fixed effects model. The study is registered on PROSPERO (26/05/2016 CRD42016038780).
RESULTS
RESULTS
Our final analysis comprised 31 studies (26,204 patients, 11,711 patients given sulfonylureas and 14,493 given comparator drugs). In comparison to drugs with low hypoglycaemic potential, sulfonylureas had higher odds for all-cause mortality (OR 1.32, 95% CI 1.00-1.75), MACE (OR 1.32, 95% CI 1.07-1.61), myocardial infarction (fatal and non-fatal) (OR 1.67, 95% CI 1.17-2.38) and hypoglycaemia (OR 5.24, 95% CI 4.20-6.55). Subsequent sensitivity analysis revealed differences in the effect of sulfonylureas, with an increased risk of all-cause mortality with glipizide but not the other molecules.
CONCLUSION
CONCLUSIONS
Our meta-analysis raises concern about the safety of SUs compared to alternative drugs involved in current analysis. Important differences may exist within the drug class, and glimepiride seems to have best safety profile.
Identifiants
pubmed: 36261824
doi: 10.1186/s12902-022-01158-5
pii: 10.1186/s12902-022-01158-5
pmc: PMC9580135
doi:
Substances chimiques
Hypoglycemic Agents
0
Glipizide
X7WDT95N5C
Dipeptidyl-Peptidase IV Inhibitors
0
Metformin
9100L32L2N
Sodium-Glucose Transporter 2 Inhibitors
0
Glucagon-Like Peptide 1
89750-14-1
Dipeptidyl-Peptidases and Tripeptidyl-Peptidases
EC 3.4.14.-
Symporters
0
Glucose
IY9XDZ35W2
Sodium
9NEZ333N27
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
251Subventions
Organisme : Estonian Ministry of Education and Research
ID : IUT34-17
Organisme : Estonian Ministry of Education and Research
ID : IUT34-17
Organisme : Estonian Ministry of Education and Research
ID : IUT34-17
Organisme : Estonian Ministry of Education and Research
ID : IUT34-17
Informations de copyright
© 2022. The Author(s).
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