Third-line diabetes drugs offer comparable results

By Alisdair Stirling

GPs can base choice of third-line diabetes drugs on patient preferences and clinical characteristics as they all achieve comparable levels of blood sugar control, according to a new meta-analysis.

There was no clear difference between insulin, acarbose, glitazones, GLP-1 agonists, and gliptins in the reduction in blood glucose levels when added to a metformin and sulfonylurea regimen, the study showed.

Researchers analysed data from 18 published trials of at least 24 weeks in duration to evaluate the effects of adding a third antihyperglycaemic drug to the treatment of 4,535 adults aged 18 years or older with type 2 diabetes and HbA1c level of 7% or higher who were already receiving treatment with metformin and sulfonylurea.

Compared with placebo, drug classes did not differ in their effect on HbA1c level. Reductions seen ranged from 0.7% for acarbose to 1.1% for insulin.

Study leader Dr Jorge Gross, an endocrinologist at the Hospital de Cl?nicas de Porto Alegre in Brazil said: ‘There is no clear difference in benefit between drug classes when adding a third agent to treatment of patients with type 2 diabetes who are already receiving metformin and a sulfonylurea. The most appropriate option should depend on each patient's clinical characteristics.'

Annals of Internal Medicine. 2011;154:672-679