Benefits and Harms of Drug Treatment for Type 2 Diabetes: Systematic Review and Network Meta-Analysis of Randomised Controlled Trials
BMJ 2023;381:e074068 DOI 10.1136/bmj-2022-074068
Keeping abreast of the rising volume of randomized trials in adults with type 2 diabetes presents a formidable task. Recent randomized trials have shown cardiovascular and kidney advantages with finerenone, an innovative non-steroidal mineralocorticoid receptor antagonist, and weight loss with tirzepatide, a dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 (GLP-1) receptor agonist.
This network meta-analysis unveils varied benefits and drug-specific detriments across 13 drug classes. Along with affirming the significant cardiovascular and kidney advantages of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and GLP-1 receptor agonists—whose absolute impacts heavily rely on patient risk profiles—it reveals that finerenone, a newly available drug, probably reduces all-cause mortality, admission to hospital for HF and ESKD. Tirzepatide outperforms SGLT-2 inhibitors and GLP-1 receptor agonists in terms of weight loss benefits.
These outcomes underscore the necessity for continual evaluation of scientific advancements to incorporate the latest updates into clinical practice guidelines for individuals with type 2 diabetes.
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