Glucagon‐like peptide‐1 receptor agonists versus insulin in inadequately controlled patients with type 2 diabetes mellitus: a meta‐analysis of clinical trials

Jun 10, 2011Diabetes, obesity & metabolism

Glucagon-like peptide-1 receptor drugs compared to insulin in people with poorly controlled type 2 diabetes: a combined analysis of clinical trials

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Abstract

Data from eight randomized controlled trials involving 2782 patients indicate that glucagon-like peptide-1 receptor agonists (GLP-1 RA) may be more effective than insulin therapy in managing type 2 diabetes.

Patients treated with GLP-1 RA experienced a mean reduction in HbA1c of -0.14% compared to insulin.
Weight loss was significantly greater in the GLP-1 RA group, averaging -4.40 kg more than in the insulin group.
Fasting plasma glucose levels increased by 1.18 mmol/l more in the insulin group compared to the GLP-1 RA group.
The GLP-1 RA group was associated with a lower incidence of hypoglycaemia, with an odds ratio of 0.45.
There was no significant difference in severe hypoglycaemia occurrences between the two treatment groups.
Gastrointestinal adverse events were reported significantly more often in the GLP-1 RA group, with an odds ratio of 15.00.

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To compare the effect and safety of glucagon-like peptide-1 receptor agonists (GLP-1 RA) with insulin therapy on type 2 diabetes mellitus (T2DM) patients inadequately controlled with metformin and/or sulfonylurea. A systematic literature search on MEDLINE, Embase and Cochrane for randomized controlled trials (RCTs) was conducted using specific search terms 'GLP-1 insulin type 2 diabetes clinical trials' and eight eligible studies were retrieved. Data on mean change in haemoglobin A1c (HbA1C), weight loss, fasting plasma glucose (FPG), incidence of hypoglycaemia and gastrointestinal adverse events were extracted from each study and pooled in meta-analysis. Data on postprandial plasma glucose (PPG) and adverse events were also described or tabulated. Data from eight RCTs enrolling 2782 patients were pooled using a random-effects model. The mean net change [95% confidence interval (CIs)] for HbA1c, weight loss and FPG for patients treated with GLP-1 RA as compared with insulin was -0.14% (-2 mmol/mol) [95% CI; (-0.27, -0.02)%; p = 0.03]; -4.40 kg [95% CI; (-5.23, -3.56) kg; p < 0.01] and 1.18 mmol/l [95% CI; (0.43, 1.93) mmol/l; p < 0.01], respectively, with negative values favouring GLP-1 and positive values favouring insulin. The GLP-1 group was associated with a greater reduction in PPG than the insulin group. Overall, hypoglycaemia was reported less in the GLP-1 group [Mantel-Haenszel odds ratio (M-H OR) 0.45 (0.27, 0.76); p < 0.01], while there was no significant difference in occurrence of severe hypoglycaemia [M-H OR 0.65 (0.29,1.45); p = 0.29]. A significantly higher number of gastrointestinal adverse events were reported with GLP-1 group [M-H OR 15.00 (5.44,41.35) p < 0.01]. GLP-1 RA are promising new agents compared with insulin. Further prospective clinical trials are expected to fully evaluate the long-term effectiveness and safety of these therapies within the T2DM treatment paradigm.

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Glucagon‐like peptide‐1 receptor agonists versus insulin in inadequately controlled patients with type 2 diabetes mellitus: a meta‐analysis of clinical trials

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