Comparison of cardiovascular and metabolic outcomes in people with type 2 diabetes on insulin versus non-insulin glucose-lowering therapies (GLTs): A systematic review and meta-analysis of clinical trials.
OBJECTIVES: To compare the cardiovascular and metabolic outcomes of Insulin versus non-insulin glucose lowering therapy (GLT). METHODS: We included randomised control trials (RCTs) which randomised patients aged >18years with Type 2 Diabetes (T2D) to insulin vs non-insulin GLT. We used risk ratios (RR), risk difference (RD) and odds ratios (OR) with 95% confidence interval (95%CI) to analyse the treatment effects of dichotomous outcomes and mean differences (with 95% CI) for continuous outcomes. RESULTS: We included 18 RCTs with 19,300 participants. There was no significant difference in the risk of all-cause mortality and CV events between the groups (RR=1.01; 95%CI: 0.96-1.06; p=0.69). In 16 trials, insulin showed greater efficacy in glycaemic control (mean diff=-0.20; 95%CI: -0.28 to -0.11) but the proportion achieving HbA1c level of either ⩽7.0% or 7.4% (53 or 57mmol/mol) was similar in both (OR=1.55; 95%CI=0.92-2.62). The non-insulin group had a significant reduction in weight (mean diff=-3.41; 95%CI: -4.50 to -2.32) and an increase in the proportion of adverse events (54.7% vs 45.3%, p=0.044), but the insulin group showed an (RR=1.90; 95%CI: 1.44-2.51) increased risk of hypoglycaemia. CONCLUSION: There was no difference in the risk of all-cause mortality and adverse cardiovascular (CV) events between Insulin and non-insulin GLTs. Insulin was associated with superior reduction in HbA1c; least reduction in weight and higher risk of hypoglycaemia. Both showed similar proportion of patients achieving HbA1c target. Non-insulin GLTs were associated with a higher risk in reported adverse drug events.
Item Type | Article |
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Keywords | Body Weight/drug effects, Cardiovascular Diseases/*chemically induced/epidemiology, Diabetes Mellitus, Type 2/complications/*drug therapy/mortality, Female, Glycemic Index, Hemoglobin A, Glycosylated/metabolism, Humans, Hypoglycemia/chemically induced/epidemiology, Hypoglycemic Agents/adverse effects/*therapeutic use, Insulin/adverse effects/*therapeutic use, Male, Middle Aged, Risk, Survival Rate, Treatment Outcome, Cardiovascular, Insulin, Meta-analysis, Metabolic, Non-insulin, Body Weight, drug effects, Cardiovascular Diseases, chemically induced, epidemiology, Diabetes Mellitus, Type 2, complications, drug therapy, mortality, Female, Glycemic Index, Hemoglobin A, Glycosylated, metabolism, Humans, Hypoglycemia, chemically induced, epidemiology, Hypoglycemic Agents, adverse effects, therapeutic use, Insulin, adverse effects, therapeutic use, Male, Middle Aged, Risk, Survival Rate, Treatment Outcome |
ISI | 390460100010 |