Glucagon-like peptide-1 receptor agonists in type 2 diabetes: a meta-analysis of randomized clinical trials

Mar 26, 2009European journal of endocrinology

Effects of glucagon-like peptide-1 receptor drugs on type 2 diabetes: a combined analysis of clinical trials

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Abstract

A total of 21 randomized controlled trials involving 5429 patients showed a significant improvement in HbA1c with GLP-1 receptor agonists.

GLP-1 receptor agonists lead to a reduction in HbA1c by -1.0 when compared to placebo.
There is a low risk of hypoglycaemia associated with the use of GLP-1 receptor agonists.
No evidence suggests an increased cardiovascular risk with GLP-1 receptor agonists.
GLP-1 receptor agonists are associated with weight loss and gastrointestinal side effects.
These agents are effective in lowering both HbA1c and postprandial glucose levels.
In patients not responding to sulphonylureas and/or metformin, GLP-1 receptor agonists show similar effectiveness as insulin.

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OBJECTIVE: The role of glucagon-like peptide-1 (GLP-1) receptor agonists in the treatment of type 2 diabetes is debated; many recent trials, which were not included in previous meta-analyses, could add relevant information.

DESIGN AND METHODS: All available randomized controlled trials (RCTs), either published or unpublished, performed in type 2 diabetic patients with GLP-1 receptor agonists (exenatide and liraglutide), with a duration>12 weeks were meta-analysed for HbA1c, body mass index, hypoglycaemia and other adverse events.

RESULTS AND CONCLUSIONS: A total of 21 RCTs (six of which unpublished), enrolling 5429 and 3053 patients (with GLP-1 receptor agonists and active comparator or placebo respectively), was retrieved and included in the analysis. GLP-1 receptor agonists determine a significant improvement of HbA1c in comparison with placebo (-1.0 (-1.1, -0.8), P<0.001), with a low risk of hypoglycaemia. There is no evidence of increased cardiovascular risk with the use of GLP-1 receptor agonists. GLP-1 receptor agonists, which induce weight loss, are associated with gastrointestinal side effects. GLP-1 receptor agonists are effective in reducing HbA1c and postprandial glucose. In patients failing to sulphonylureas and/or metformin, GLP-1 receptor agonists are similarly effective as insulin. Available data suggest that the efficacy and tolerability of the novel agent, liraglutide, which is adequate for once-a-day administration, are comparable with those of exenatide bis in die.

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Glucagon-like peptide-1 receptor agonists in type 2 diabetes: a meta-analysis of randomized clinical trials

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