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The 'Old' Anti-Diabetic Agents: A Systematic Inventory.

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    Metformin shows benefits for overweight type 2 diabetes patients, while sulfonylureas lack a class effect. The efficacy of older oral diabetes agents on hard clinical outcomes remains uncertain, impacting treatment policy interpretation.

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    Area of Science:

    • Endocrinology
    • Pharmacology
    • Internal Medicine

    Background:

    • Type 2 diabetes management involves various oral hyperglycaemia agents.
    • Older oral agents include metformin, sulfonylureas (SUs), thiazolidinediones, alpha glucosidase inhibitors, and meglitinides.

    Purpose of the Study:

    • To systematically review 'old' oral agents for type 2 diabetes.
    • To critically evaluate their efficacy on patient-relevant outcomes.

    Main Methods:

    • Systematic inventory of twelve meta-analyses and six randomized controlled trials.
    • Focus on studies with patient-relevant primary endpoints.

    Main Results:

    • Metformin demonstrated benefits for 'any diabetes-related endpoint' and 'all-cause mortality' in specific patient groups.
    • Sulfonylureas (SUs) do not exhibit a class effect; only glyburide showed benefits for microvascular complications.
    • Thiazolidinediones (e.g., rosiglitazone) carry increased coronary risks; alpha glucosidase inhibitors and meglitinides have uncertain benefit-to-risk ratios for hard endpoints.

    Conclusions:

    • Current evidence on older oral agents' effects on hard clinical endpoints is limited and often uncertain.
    • Individualized diabetes treatment is complex; interpreting treatment policy efficacy is speculative without clear single-agent data.