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245 00 a| Oral diabetes medications for adults with type 2 diabetesh| [electronic resource] :b| an update /c| prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Johns Hopkins University Evidence-based Practice Center ; investigators, Wendy L. Bennett ... [et al.].;

260 a| Rockville, MD :b| Agency for Healthcare Research and Quality,;

300 a| 1 online resource (PDF file (various pagings)) :b| ill.;

490 1 a| Comparative effectiveness review ;v| no. 27;

490 1 a| AHRQ publication ;v| no. 11-EHC035-EF;

500 a| "Contract No. 290-02-0018.";

500 a| "March 2011.";

504 a| Includes bibliographical references.;

506 a| Available only to authorized users.;

520 3 a| OBJECTIVES: Given the number of medications available for type 2 diabetes mellitus, clinicians and patients need information about their effectiveness and safety to make informed choices. The objective of this review was to summarize the benefits and harms of medications (metformin, second-generation sulfonylureas, thiazolidinediones, meglitinides, dipeptidyl peptidase-4 [DPP-4] inhibitors, and glucagon-like peptide-1 [GLP-1] receptor agonists), as monotherapy and in combination, for the treatment of adults with type 2 diabetes. DATA SOURCES: We searched the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases from inception through April 2010 for original English-language articles and sought unpublished data from the Food and Drug Administration and others. REVIEW METHODS: Two reviewers independently screened titles to identify studies that assessed intermediate outcomes (e.g., hemoglobin A1c [HbA1c]), long-term clinical outcomes (e.g., mortality), and harms (e.g., hypoglycemia) in head-to-head monotherapy or combination therapy comparisons. Two reviewers serially extracted data for each article using standardized protocols, assessed applicability, and independently evaluated study quality. RESULTS: The review included 140 randomized controlled trials and 26 observational studies. We graded evidence as low or insufficient for long-term clinical outcomes of all-cause mortality, cardiovascular disease, nephropathy, and neuropathy. Most medications lowered HbA1c on average by 1 absolute percentage point, but metformin was more efficacious than the DPP-4 inhibitors. Two-drug combinations had similar HbA1c reduction. Compared with metformin, thiazolidinediones and sulfonylureas had a more unfavorable effect on weight (mean difference of +2.6 kg). Metformin decreased low density lipoprotein cholesterol relative to pioglitazone, sulfonylureas, and DPP-4 inhibitors. Sulfonylureas had a fourfold higher risk of mild/moderate hypoglycemia compared with metformin alone, and, in combination with metformin, had more than a fivefold increased risk compared with metformin plus thiazolidinediones. Thiazolidinediones had an increased risk of congestive heart failure relative to sulfonylureas and bone fractures relative to metformin. Diarrhea occurred more often for metformin compared with thiazolidinedione users. CONCLUSIONS: Comprehensive information comparing benefits and harms of diabetes medications can facilitate personalized treatment choices for patients. Although the long-term benefits and harms of diabetes medications remain unclear, the evidence supports use of metformin as a first-line agent. Comparisons of two-drug combinations showed little to no difference in HbA1c reduction, but some combinations increased risk for hypoglycemia and other adverse events.;

536 a| Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 540 Gaither Road, Rockville, MD 20850; www.ahrq.gov Contract Number: 290-02-0018, Prepared by: Johns Hopkins University Evidence-based Practice Center, Baltimore, MD.;

538 a| Mode of access: World Wide Web;

588 a| Description based on online resource; title from PDF title page (viewed on Jan. 27, 2012).;

650 12 a| Diabetes Mellitus, Type 2x| drug therapy0| https://id.nlm.nih.gov/mesh/D003924Q000188=| ^A1202407;

650 22 a| Hypoglycemic Agentsx| therapeutic use0| https://id.nlm.nih.gov/mesh/D007004Q000627=| ^A1058025;

650 22 a| Hypoglycemic Agentsx| adverse effects0| https://id.nlm.nih.gov/mesh/D007004Q000009=| ^A1336475;

650 22 a| Treatment Outcome0| https://id.nlm.nih.gov/mesh/D016896=| ^A929292;

655 0 a| Electronic books.=| ^A491897;

700 1 a| Bennett, Wendy L.=| ^A1330064;

710 1 a| United States.b| Agency for Healthcare Research and Quality.=| ^A457038;

710 2 a| Effective Health Care Program (U.S.)=| ^A1082354;

710 2 a| Johns Hopkins University.b| Evidence-based Practice Center.=| ^A571127;

830 0 a| Comparative effectiveness reviewv| no. 27.=| ^A1169772;

830 0 a| AHRQ publication ;v| no. 11-EHC038-EF.=| ^A457037;

856 40 z| Full text available from FreeBooks4Doctorsu| http://www.ncbi.nlm.nih.gov/books/NBK55754/;

947 a| (OCoLC)774949081;

949 a| CLICK ON WEB ADDRESSw| ASISh| JOYNER188;

949 a| CLICK ON WEB ADDRESSw| ASISh| HSL77;

949 a| CLICK ON WEB ADDRESSw| ASISh| JMUSIC60;

596 a| 1 3 4;

998 a| 4214222;

999 a| CLICK ON WEB ADDRESSw| ASISc| 1i| 4214222-1001l| JNETm| JOYNERr| Ys| Yt| JNESSBKu| 1/2/2016x| EBOOKz| JERESOURCE;

999 a| CLICK ON WEB ADDRESSw| ASISc| 1i| 4214222-2001l| HSLELECm| HSLr| Ys| Yt| HEBKu| 1/2/2016x| EBOOKz| HERESOURCE;

999 a| CLICK ON WEB ADDRESSw| ASISc| 1i| 4214222-3001l| MNETm| JMUSICr| Ys| Yt| MNESSBKu| 1/2/2016x| EBOOKz| JERESOURCE;

Oral diabetes medications for adults with type 2 diabetes an update / prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Johns Hopkins University Evidence-based Practice Center ; investigators, Wendy L. Bennett ... [et al.].

Format	Electronic
Publication Info	Rockville, MD : Agency for Healthcare Research and Quality,
Description	1 online resource (PDF file (various pagings)) : ill.
Supplemental Content	Full text available from FreeBooks4Doctors
Subjects	Diabetes Mellitus, Type 2--drug therapy. Hypoglycemic Agents--therapeutic use. Hypoglycemic Agents--adverse effects. Treatment Outcome

Other author/creator	Bennett, Wendy L.
Other author/creator	United States. Agency for Healthcare Research and Quality.
Other author/creator	Effective Health Care Program (U.S.)
Other author/creator	Johns Hopkins University. Evidence-based Practice Center.
Series	Comparative effectiveness review ; no. 27 AHRQ publication ; no. 11-EHC035-EF Comparative effectiveness review no. 27. ^A1169772 AHRQ publication ; no. 11-EHC038-EF. ^A457037
Summary	OBJECTIVES: Given the number of medications available for type 2 diabetes mellitus, clinicians and patients need information about their effectiveness and safety to make informed choices. The objective of this review was to summarize the benefits and harms of medications (metformin, second-generation sulfonylureas, thiazolidinediones, meglitinides, dipeptidyl peptidase-4 [DPP-4] inhibitors, and glucagon-like peptide-1 [GLP-1] receptor agonists), as monotherapy and in combination, for the treatment of adults with type 2 diabetes. DATA SOURCES: We searched the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases from inception through April 2010 for original English-language articles and sought unpublished data from the Food and Drug Administration and others. REVIEW METHODS: Two reviewers independently screened titles to identify studies that assessed intermediate outcomes (e.g., hemoglobin A1c [HbA1c]), long-term clinical outcomes (e.g., mortality), and harms (e.g., hypoglycemia) in head-to-head monotherapy or combination therapy comparisons. Two reviewers serially extracted data for each article using standardized protocols, assessed applicability, and independently evaluated study quality. RESULTS: The review included 140 randomized controlled trials and 26 observational studies. We graded evidence as low or insufficient for long-term clinical outcomes of all-cause mortality, cardiovascular disease, nephropathy, and neuropathy. Most medications lowered HbA1c on average by 1 absolute percentage point, but metformin was more efficacious than the DPP-4 inhibitors. Two-drug combinations had similar HbA1c reduction. Compared with metformin, thiazolidinediones and sulfonylureas had a more unfavorable effect on weight (mean difference of +2.6 kg). Metformin decreased low density lipoprotein cholesterol relative to pioglitazone, sulfonylureas, and DPP-4 inhibitors. Sulfonylureas had a fourfold higher risk of mild/moderate hypoglycemia compared with metformin alone, and, in combination with metformin, had more than a fivefold increased risk compared with metformin plus thiazolidinediones. Thiazolidinediones had an increased risk of congestive heart failure relative to sulfonylureas and bone fractures relative to metformin. Diarrhea occurred more often for metformin compared with thiazolidinedione users. CONCLUSIONS: Comprehensive information comparing benefits and harms of diabetes medications can facilitate personalized treatment choices for patients. Although the long-term benefits and harms of diabetes medications remain unclear, the evidence supports use of metformin as a first-line agent. Comparisons of two-drug combinations showed little to no difference in HbA1c reduction, but some combinations increased risk for hypoglycemia and other adverse events.
General note	"Contract No. 290-02-0018."
General note	"March 2011."
Bibliography note	Includes bibliographical references.
Access restriction	Available only to authorized users.
Funding information	Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 540 Gaither Road, Rockville, MD 20850; www.ahrq.gov Contract Number: 290-02-0018, Prepared by: Johns Hopkins University Evidence-based Practice Center, Baltimore, MD.
Technical details	Mode of access: World Wide Web
Source of description	Description based on online resource; title from PDF title page (viewed on Jan. 27, 2012).
Genre/form	Electronic books.

Oral diabetes medications for adults with type 2 diabetes an update / prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Johns Hopkins University Evidence-based Practice Center ; investigators, Wendy L. Bennett ... [et al.].

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