Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes: A Systematic Review and Meta-analysis

This review of 204 studies showed similar reductions in HbA1c across monotherapies and metformin-based combinations, except DPP-4 inhibitors (DDP-4I) had smaller effects; body weight was reduced/maintained with metformin, DPP-4I, GLP-1 receptor agonists, and SGLT-2 inhibitors.

The authors highlight limitations of the review, such as the exclusion of studies in which patients took other drugs for diabetes which were not included.

 

Additionally, low strength of evidence on heart failure risk was found, but because of imprecision when comparing thiazolidinediones with metformin and sulfonylureas, the large RECORD (Rosiglitazone Evaluated for Cardiovascular Outcomes and Regulation of glycemia in Diabetes) trial was excluded from the assessment of the heart failure outcome because it compared thiazolidinediones with metformin or sulfonylureas without stratifying results.