We recently reported on a review of GLP-1 analogues as a second line of treatment in type 2 diabetes. A new systematic review reports on a direct comparison with insulin therapy in poorly controlled type 2 diabetes.
In type 2 diabetes poorly controlled on oral therapy, do GLP-1 analogues as compared with insulin, improve glycaemic control or reduce complications?
The reviewers found 7 randomised trials, involving 2,199 participants, that compared GLP-1 analogues with insulin. When they pooled the data from these studies they found:
- no significant difference between the two in terms of overall glycaemic control (HbA1c).
- more weight gain in the patients treated with insulin.
- a 35% reduction in the risk of hypoglycaemia in the patients treated with GLP-1 analogues.
Users of this research should consider:
- It is almost certain that the reviewers missed important research by only searching the PubMed database.
- Did they do enough to evaluate the quality of the trials?
- Does it make sense to combine their results? Were the patients, treatment regimens and outcome measures used in the different trials sufficiently similar to warrant meta-analysis?
- How much uncertainty there is around the estimates of benefit for rare outcomes such as hypoglyaemia. The sample size of the meta-analysis was rather small.
- The possible safety issues associated with GLP-1 analogues.
Abdul-Ghani MA, Williams K, Kanat M, Altuntas Y, Defronzo RA. Insulin Versus GLP-1 Analogues in Poorly Controlled Type 2 Diabetic Subjects on Oral Therapy A Meta Analysis. J Endocrinol Invest. 2012 Apr 18. [Epub ahead of print]