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Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update [Internet]

Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update [Internet]

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US)

Version: March 2011


A summary of the search results is presented in Figure 2. From the search, we retrieved 20,748 unique citations. After a review of the titles and abstracts, 1,027 were deemed eligible for further review, and the full articles were retrieved. A total of 166 articles were included in this review.


Type 2 diabetes is a common chronic illness, with an increasing prevalence that parallels the rise in obesity rates. Type 2 diabetes is characterized by insulin resistance, which is worsened by obesity and physical inactivity. Over time, the pancreatic beta cells lose their ability to maintain the high insulin levels needed to counter liver and muscle insulin resistance and beta cell failure occurs. The natural history of type 2 diabetes has been described in several populations.


This systematic review addresses the comparative effectiveness and safety of diabetes medications used most frequently in the United States as monotherapy and in combination therapy with each other and with insulin preparations. This review updates and adds to a previous comparative effectiveness review (CER) published in 2007 comparing the effectiveness and safety of oral diabetes medications, mainly as monotherapy.

Executive Summary

Type 2 diabetes is a common chronic illness characterized by insulin resistance and eventually by decreased insulin secretion by pancreatic beta cells, leading to chronic hyperglycemia and associated long-term disease complications. In the United States, the prevalence of diabetes increased from 5.1 percent during 1988–1994 to 6.5 percent during 1999–2002. Like many chronic illnesses, diabetes disproportionately affects older people. It is associated with obesity, and its prevalence is higher among racial and ethnic minority populations. The annual economic burden of diabetes is estimated to be $132 billion and is increasing, mostly because of the costly complications of the disease.


The Agency for Healthcare Research and Quality (AHRQ) requested an update to Comparative Effectiveness Review No. 8, Comparative Effectiveness and Safety of Oral Diabetes Medications For Adults with Type 2 Diabetes. In addition, AHRQ requested that the scope be broadened to include a review of the comparative effectiveness and safety of combinations of medications for diabetes treatment. Our Evidence-based Practice Center (EPC) established a team and a work plan to develop the evidence report. The project involved recruiting technical experts, formulating and refining the questions, performing a comprehensive literature search, summarizing the state of the literature, constructing evidence tables, synthesizing the evidence, and submitting the report for peer review.

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