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Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Br+J+Clin+Pharmacol 2016 ; 82 (5): 1291-302 Nephropedia Template TP
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Hypoglycaemia when adding sulphonylurea to metformin: a systematic review and network meta?analysis #MMPMID27426428
Andersen SE; Christensen M
Br J Clin Pharmacol 2016[Nov]; 82 (5): 1291-302 PMID27426428show ga
Aims: The risk of hypoglycaemia may differ among sulphonylureas (SUs), but evidence from head?to?head comparisons is sparse. Performing a network meta?analysis to use indirect evidence from randomized controlled trials (RCTs), we compared the relative risk of hypoglycaemia with newer generation SUs when added to metformin. Methods: A systematic review identified RCTs lasting 12?52 weeks and evaluating SUs added to inadequate metformin monotherapy (?1000 mg/day) in type 2 diabetes. Adding RCTs investigating the active comparators from the identified SU trials, we established a coherent network. Hypoglycaemia of any severity was the primary end point. Results: Thirteen trials of SUs and 14 of oral non?SU antihyperglycaemic agents (16?260 patients) were included. All reported hypoglycaemia only as adverse events. Producing comparable reductions in HbA1C of ?0.66 to ?0.84% (?7 to ?9 mmol/mol), the risk of hypoglycaemia was lowest with gliclazide compared to glipizide (OR 0.22, CrI: 0.05 to 0.96), glimepiride (OR 0.40, CrI: 0.13 to 1.27), and glibenclamide (OR 0.21, CrI: 0.03 to 1.48). A major limitation is varying definitions of hypoglycaemia across studies. Conclusions: When added to metformin, gliclazide was associated with the lowest risk of hypoglycaemia between the newer generation SUs. Clinicians should consider the risk of hypoglycaemia agent?specific when selecting an SU agent.