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The effects of sulfonylureas plus metformin on lipids, blood pressure, and adverse events in type 2 diabetes: a meta-analysis of randomized controlled trials

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Abstract

To compare the effects of sulfonylureas and metformin versus metformin on lipid profiles, blood pressure, and adverse events. PubMed, EMbase, Chinese BioMedical Literature on disc, China National Knowledge Infrastructure, VIP database, and Wanfang database were searched for randomized controlled trials (RCTs), from inception to August 2012. Key outcomes were low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), total cholesterol (TC), blood pressure (BP), hemoglobin A1c (HbA1c), fasting insulin, and adverse events. Twenty RCTs were included in the analysis. Compared to metformin, the combination therapy of sulfonylureas and metformin slightly reduced HDL-C [−0.03, 95 % CI (−0.06, −0.01)] and HbA1c (−0.79, 95 % CI −0.96 to −0.63). However, it showed little effects on LDL-C, TG, TC, and BP. Glipizide plus metformin significantly increased fasting insulin [2.33, 95 % CI (1.94, 2.73)]. Hypoglycemia and nervous system side events were more frequent among patients treated with sulfonylureas plus metformin than metformin alone (RR = 6.79, 95 % CI 3.79–12.17; RR = 1.27, 95 % CI 1.03–1.57; respectively), but less in digestive symptoms (RR = 0.75, 95 % CI 0.67–0.84). Combination therapy with sulfonylureas and metformin may be more effective than metformin alone in improving HbA1c and reducing gastrointestinal reactions. But it had disadvantage of decreasing HDL-C, increasing the risk of hypoglycemia and nervous system side events.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China

    Fan Zhang, Yunzhou Fan, Tsend-ayush Ganchuluun, Wenhua Kong, Qian Ouyang, Jingwen Sun, Beibei Cao, Hongbo Jiang & Shaofa Nie

  2. School of Public Health, Wuhan University, Wuhan, Hubei, China

    Hao Xiang

  3. Wuhan University Global Health Institute, Wuhan, Hubei, China

    Hao Xiang

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  1. Fan Zhang
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Correspondence to Shaofa Nie.

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Fan Zhang and Hao Xiang contributed equally to this study.

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Zhang, F., Xiang, H., Fan, Y. et al. The effects of sulfonylureas plus metformin on lipids, blood pressure, and adverse events in type 2 diabetes: a meta-analysis of randomized controlled trials. Endocrine 44, 648–658 (2013). https://doi.org/10.1007/s12020-013-9970-6

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  • DOI: https://doi.org/10.1007/s12020-013-9970-6

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