Bottom Line: In a comparison of different classes of drugs used to lower blood sugar levels for patients with type 2 diabetes, sodium-glucose cotransporter 2 (SGLT-2) inhibitors or glucagon-like peptide 1(GLP-1) agonists were associated with a lower risk of death than dipeptidyl peptidase 4 (DPP-4) inhibitors or control (placebo or no treatment).
Why The Research Is Interesting: Several drug classes have emerged that are effective in improving blood sugar control for patients with type 2 diabetes, including SGLT-2 and DPP-4 inhibitors and GLP-1 agonists. The clinical effectiveness of these drugs compared to each other is not known.
Who and When: 176,310 study participants with type 2 diabetes in 236 randomized clinical trials in databases through October 2017
What (Study Measures): SGLT-2 inhibitors, GLP-1 agonists, DPP-4 inhibitors, and control (placebo, no treatment) (interventions); death from any cause (outcome).
How (Study Design): This was a network meta-analysis, which combines the results of multiple studies identified in a systematic review and quantitatively summarizes the overall association between interventions and outcomes measured across all studies.
Authors: Sean L. Zheng, B.M., B.Ch., M.A., M.R.C.P., Imperial College Healthcare NHS Foundation Trust, London, and coauthors
Study Limitations: Network meta-analysis respects randomization of clinical trials, but itself represents observational data, preventing conclusions on causality from being inferred.
Study Conclusions: In patients with type 2 diabetes, the use of SGLT-2 inhibitors or GLP-1 agonists was associated with better survival than DPP-4 inhibitors.
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(doi:10.1001/jama.2018.3024)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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Journal
JAMA