Oral anti-diabetic drugs for the prevention of Type 2 diabetes
Diabetic Medicine,  Clinical Article

Phung OJ et al. – Of the oral anti–diabetic drugs evaluated to prevent Type 2 diabetes, thiazolidinediones were associated with the greatest risk reduction compared with control and associated with greater risk reduction than biguanides. Alpha–glucosidase inhibitors and biguanides performed similarly, and better than control, while sulphonylureas and glinides provided no significant benefit.

Methods
  • A systematic literature search of MEDLINE, EMBASE and Cochrane CENTRAL was conducted for randomized controlled trials evaluating oral anti–diabetic drugs in patients at high risk for developing Type 2 diabetes.
  • Mixed–treatment comparison meta–analysis methods were used to evaluate the relative risks and risk differences of developing Type 2 diabetes, along with associated 95% credible intervals.

Results
  • 20 trials (n=23230 participants) were included.
  • Upon mixed–treatment comparison meta–analysis, thiazolidinediones, alpha–glucosidase inhibitors and biguanides significantly reduced the relative risk of developing diabetes by 64, 40 and 27%, respectively, compared with control.
  • Sulphonylureas and glinides showed no significant effect.
  • thiazolidinediones significantly reduced the relative risk of diabetes by 50% compared with biguanides and trended towards a 40% risk reduction vs. alpha–glucosidase inhibitors [relative risk 0.60 (95% credible intervals 0.34–1.02)].
  • None of the results were appreciably altered upon subgroup or sensitivity analyses.
  • When evaluating risk differences compared with control, thiazolidinediones (-9%, number needed to treat=11), alpha–glucosidase inhibitors (-7%, number needed to treat=14) and biguanides (-7%, number needed to treat=14) continued to show significant benefit.

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