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Pioglitazone, SGLT2 inhibitors equally effective for reducing HbA1c
Pioglitazone and SGLT2 inhibitors as add-ons to insulin therapy were more effective for lowing HbA1c, fasting plasma glucose and insulin dose requirements in patients with type 2 diabetes than insulin alone, according to results from a meta-analysis.
Chang Hee Jung, MD, PhD, of the department of internal medicine at Asan Medical Center, University of Ulsan College of Medicine in Korea, and colleagues conducted a systematic review and indirect comparison meta-analysis of six randomized controlled trials involving 2,938 participants with type 2 diabetes randomly assigned to the thiazolidinedione pioglitazone or placebo and eight randomized controlled trials involving 4,288 participants with type 2 diabetes randomly assigned to SGLT2 inhibitors or placebo conducted through Dec. 31, 2016. Researchers sought to determine the safety and efficacy of pioglitazone and SGLT2 inhibitors as add-ons to insulin therapy for type 2 diabetes management.
Compared with the placebo groups, both the pioglitazone and SGLT2 inhibitor groups were associated with a greater reduction of HbA1c (P < .001 for both); reduction in HbA1c did not significantly differ between the pioglitazone and SGLT2 inhibitor groups.
Four pioglitazone and six SGLT2 inhibitor studies examined changes in FPG levels from baseline; both groups exhibited reduced FPG levels compared with the placebo groups (P < .001 for both). Reduction in FPG from baseline did not significantly differ between the pioglitazone and SGLT2 inhibitor groups in unadjusted indirect comparison or after adjustment for age, sex, BMI and baseline HbA1c.
The proportions of participants who achieved the target HbA1c level of less than 7% were reported in two pioglitazone and three SGLT2 inhibitor studies; both the pioglitazone (P = .041) and SGLT2 inhibitor (P < .001) groups had more participants who achieved HbA1c less than 7% compared with the placebo groups.
Change in body weight was assessed in five pioglitazone and seven SGLT2 inhibitor studies. Compared with the placebo groups, the SGLT2 inhibitor groups experienced weight loss (P < .001), whereas the pioglitazone groups experienced increases in weight (P < .001).
Five pioglitazone and five SGLT2 inhibitor studies assessed change in insulin dose requirement from baseline. Compared with the placebo groups, the pioglitazone (P < .001) and SGLT2 inhibitor (P = .001) groups experienced decreases in insulin dose requirements.
The risk for hypoglycemia was assessed in five pioglitazone and eight SGLT2 inhibitor studies, and the risk was higher in the pioglitazone groups compared with the SGLT2 inhibitor groups (RR = 1.24; 95% CI, 1.06-1.44).
“In the absence of a head-to-head comparison, the results of this study provide important evidence for selecting [oral antidiabetic drugs] to improve glycemic control in subjects with [type 2 diabetes] receiving insulin treatment,” the researchers wrote. – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.