Comparative Effectiveness of Glucose-Lowering Drugs for Type 2 Diabetes
Authors: Apostolos Tsapas, Thomas Karagiannis, Ioannis Avgerinos, David R. Matthews, Eleni Bekiari
Journal: Annals of Internal Medicine (2021)

LettersJanuary 2021Comparative Effectiveness of Glucose-Lowering Drugs for Type 2 DiabetesApostolos Tsapas, MD, MSc (Oxon), PhD, Thomas Karagiannis, MD, MSc, PhD, Ioannis Avgerinos, MD, MSc, David R. Matthews, MD, DPhil, Eleni Bekiari, MD, MSc, PhDApostolos Tsapas, MD, MSc (Oxon), PhDClinical Research and Evidence-Based Medicine Unit and Diabetes Centre, Aristotle University of Thessaloniki, Thessaloniki, Greece, and Harris Manchester College, University of Oxford, Oxford, United Kingdom, Thomas Karagiannis, MD, MSc, PhDClinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece, Ioannis Avgerinos, MD, MScClinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece, David R. Matthews, MD, DPhilHarris Manchester College, University of Oxford, and Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, United Kingdom, Eleni Bekiari, MD, MSc, PhDClinical Research and Evidence-Based Medicine Unit and Diabetes Centre, Aristotle University of Thessaloniki, Thessaloniki, GreeceAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1278 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate Dr. Kabadi's thoughts on the specifics of the research question of our systematic review and network meta-analysis (1), namely, the choice of clinically relevant subpopulations (drug-naive patients), interventions (all approved doses of antidiabetic agents used in clinical practice), and outcomes (absolute rather than percentage change in HbA1c levels). These decisions were addressed a priori to facilitate pragmatism and the clinical relevance of our findings.Even though exploring the association between intensive antihyperglycemic strategies and cardiovascular benefits was beyond our scope, we do share Dr. Kabadi's concerns about the complex relationship between glycemic control and cardiovascular end ...References1. Tsapas A, Avgerinos I, Karagiannis T, et al. Comparative effectiveness of glucose-lowering drugs for type 2 diabetes. A systematic review and network meta-analysis. Ann Intern Med. 2020;173:278-86. doi:10.7326/M20-0864 LinkGoogle Scholar2. Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577-89. [PMID: 18784090] doi:10.1056/NEJMoa0806470 CrossrefMedlineGoogle Scholar3. Reaven PD, Emanuele NV, Wiitala WL, et al; VADT Investigators. Intensive glucose control in patients with type 2 diabetes—15-year follow-up. N Engl J Med. 2019;380:2215-24. [PMID:31167051] doi:10.1056/NEJMoa1806802 CrossrefMedlineGoogle Scholar4. Fralick M, Colacci M, Odutayo A, et al. Lowering of hemoglobin A1c and risk of cardiovascular outcomes and all-cause mortality, a meta-regression analysis. J Diabetes Complications. 2020;34:107704. [PMID:32888788] doi:10.1016/j.jdiacomp.2020.107704 CrossrefMedlineGoogle Scholar5. Bhandari M, Busse JW, Jackowski D, et al. Association between industry funding and statistically significant pro-industry findings in medical and surgical randomized trials. CMAJ. 2004;170:477-80. [PMID: 14970094] MedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Clinical Research and Evidence-Based Medicine Unit and Diabetes Centre, Aristotle University of Thessaloniki, Thessaloniki, Greece, and Harris Manchester College, University of Oxford, Oxford, United KingdomClinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, GreeceHarris Manchester College, University of Oxford, and Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, United KingdomClinical Research and Evidence-Based Medicine Unit and Diabetes Centre, Aristotle University of Thessaloniki, Thessaloniki, GreeceDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-0864. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparative Effectiveness of Glucose-Lowering Drugs for Type 2 Diabetes Apostolos Tsapas , Ioannis Avgerinos , Thomas Karagiannis , Konstantinos Malandris , Apostolos Manolopoulos , Panagiotis Andreadis , Aris Liakos , David R. Matthews , and Eleni Bekiari Comparative Effectiveness of Glucose-Lowering Drugs for Type 2 Diabetes Udaya M. Kabadi Metrics January 2021Volume 174, Issue 1Page: 141KeywordsClinical trialsDisclosureDrugsHbA1cHeart failureHypoglycemicsSafetySafety studiesSystematic reviewsType 2 diabetes ePublished: 19 January 2021 Issue Published: January 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...