What are the findings of the AHRQ on the effectiveness and safety of oral diabetes medications?

Updated: Sep 27, 2021
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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In 2007, the AHRQ compared the effectiveness and safety of oral diabetes medications for adults with type 2 diabetes, with a 2011 update. [282, 283] The AHRQ found little evidence to support predictions as to whether a particular medication is more likely to be effective in a given patient subgroup or to cause adverse effects in a particular patient.

The AHRQ concluded that although the long-term benefits and harms of diabetes medications remain unclear, the evidence supports the use of metformin as a first-line agent. On average, monotherapy with many of the oral diabetes drugs reduces HbA1c levels by 1 percentage point (although metformin has been found to be more efficacious than the DPP-4 inhibitors), and 2-drug combination therapies reduce HbA1c about 1 percentage point more than do monotherapies.

Other AHRQ findings included the following:

  • Metformin decreased LDL cholesterol levels relative to pioglitazone, sulfonylureas, and DPP-4 inhibitors

  • Unfavorable effects on weight were greater with TZDs and sulfonylureas than with metformin (mean difference of +2.6 kg)

  • Risk of mild or moderate hypoglycemia was 4-fold higher with sulfonylureas than with metformin alone; this risk was more than 5-fold higher with sulfonylureas plus metformin than with a TZD plus metformin

  • Risk of heart failure was higher with TZDs than with sulfonylureas

  • Risk of bone fractures was higher with TZDs than with metformin

Diarrhea was more common with metformin than with glitazones.

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