Glucagon-like peptide-1 receptor agonists: A systematic review of comparative effectiveness research

Philip A. Levin, Hiep Nguyen, Eric T. Wittbrodt, Seoyoung C. Kim

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) act by increasing insulin secretion, decreasing glucagon secretion, slowing gastric emptying, and increasing satiety. Objective: Published evidence directly comparing GLP-1RAs with other approved treatments for type 2 diabetes (T2D) was systematically reviewed. Methods: A literature search was performed using MEDLINE and Embase databases to identify papers comparing GLP-1RAs with other classes of glucose-lowering therapy in patients with T2D. Results: Of the 1303 papers identified, 57 met the prespecified criteria for a high-quality clinical trial or retrospective study. The efficacy and tolerability of approved GLP-1RAs (exenatide twice daily or once weekly, dulaglutide, liraglutide, lixisenatide, and albiglutide) were compared with insulin products (23 prospective studies + seven retrospective studies), dipeptidyl peptidase-4 inhibitors (11 prospective studies + three retrospective studies), sulfonylureas (nine prospective studies + one retrospective study), thiazolidinediones (five prospective studies), and metformin (two prospective studies). GLP-1RAs are effective as a second-line therapy in improving glycemic parameters in patients with T2D. Reductions in glycated hemoglobin from baseline with GLP-1RAs tended to be greater or similar compared with insulin therapy. GLP-1RAs were consistently more effective in reducing body weight than most oral glucose-lowering drugs and insulin and were associated with lower hypoglycemia risk versus insulin or sulfonylureas. GLP-1RAs improved cardiovascular risk factors, and preliminary data suggest they improve cardiovascular outcomes in patients with T2D compared with oral glucose-lowering drugs. However, results from ongoing studies are awaited to confirm these early findings. Conclusion: This systematic review found that GLP-1RAs are an effective class of glucoselowering drugs for T2D.

Original languageEnglish (US)
Pages (from-to)123-139
Number of pages17
JournalDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy
Volume10
DOIs
StatePublished - Apr 4 2017

Keywords

  • Antidiabetic drugs
  • Randomized controlled trials
  • Retrospective
  • Type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Pharmacology

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