Diabetes

    Safety and effectiveness of dipeptidyl peptidase-4 inhibitors versus intermediate-acting insulin or placebo for patients with type 2 diabetes failing two oral antihyperglycaemic agents: a systematic review and network meta-analysis

    Tricco AC, Antony J, Khan PA, Ghassemi M, Hamid JS, Ashoor H, Blondal E, Soobiah C, Yu CH, Hutton B, Hemmelgarn BR, Moher D, Majumdar SR, Straus SE. Safety and effectiveness of dipeptidyl peptidase-4 inhibitors versus intermediate-acting insulin or placebo for patients with type 2 diabetes failing two oral antihyperglycaemic agents: a systematic review and network meta-analysis. BMJ Open. 2014;4(12):e005752. DOI: 10.1136/bmjopen-2014-005752.

     

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    Bottom Line:

    • DPP-4 inhibitors were superior to placebo in reducing HbA1c levels in adults with type 2 diabetes taking at least two oral agents. Compared with placebo, no safety signals were detected with DPP-4 inhibitors and there was a reduced risk of infection
    • There was no significant difference in HbA1c observed between NPH and placebo or NPH and DPP-4 inhibitors

    Impact:

    • Our results can be used by patients and physicians to tailor administration of these agents
    • Conducted for the British Columbia Ministry of Health to inform the decision to delist DPP-4 inhibitors for type 2 diabetes patients in British Columbia
    Funding:

    Canadian Institutes of Health Research (CIHR)/ Drug Safety and Effectiveness Network (DSEN)


    Safety, effectiveness, and cost effectiveness of long acting versus intermediate acting insulin for patients with type 1 diabetes: systematic review and network meta-analysis

    Tricco AC, Ashoor HM, Antony J, Beyene J, Veroniki AA, Isaranuwatchai W, Harrington A, Wilson C, Tsouros S, Soobiah C, Yu CH, Hutton B, Hoch JS, Hemmelgarn BR, Moher D, Majumdar SR, Straus SE. Safety, effectiveness, and cost effectiveness of long acting versus intermediate acting insulin for patients with type 1 diabetes: systematic review and network meta-analysis. BMJ. 2014;349:g5459. DOI:10.1136/bmj.g5459.

     

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    Bottom Line:

    • Patients receiving detemir once or twice daily experienced significantly fewer episodes of severe hypoglycemia compared to NPH once or twice daily. NPH once daily and detemir once daily caused significantly more weight gain, however, detemir once or twice daily caused significantly less weight gain than NPH once or twice daily

    Impact:

    • Our results can be used by patients and physicians to tailor administration of these agents
    • Conducted for the British Columbia Ministry of Health to inform the decision to continue listing the insulin in the same manner
    • Featured in >220 mass media articles
    • Used to update the World Health Organization (WHO) Model Lists of Essential Medicines
    Funding:

    Canadian Institutes of Health Research (CIHR)/ Drug Safety and Effectiveness Network (DSEN)

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    Date : 22 Mar 2016