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Type 2 Diabetes: National Clinical Guideline for Management in Primary and Secondary Care (Update)

Over 90% of people with diabetes have Type 2 diabetes. This is still perceived as the milder form, and while this may be true in some respects, such as the risk of ketoacidosis, the causation of Type 2 diabetes is more complex and the management is not necessarily easier. Type 2 diabetes can cause severe complications, affecting the eye, the nervous system and the kidney. The overall risk of cardiovascular disease is more than doubled, and life expectancy is reduced by an average 7 years. In 2002, NICE published a suite of five guidelines dealing with different aspects of the care of Type 2 diabetes. The rising prevalence of the disease, and the range of complications which can arise, reinforce the importance of up-to-date guidance and accordingly NICE have asked the National Collaborating Centre for Chronic Conditions (NCC-CC) to produce this guideline, amalgamating and updating the previously published work.

NICE Clinical Guidelines - National Collaborating Centre for Chronic Conditions (UK).

Version: 2008
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Glinides in the treatment of diabetes mellitus type 2: Executive summary of final report A05-05C, Version 1.0

The aims of this research were the comparative benefit assessments of long-term treatment with: nateglinide or repaglinide in each case vs. placebo or no treatment, nateglinide or repaglinide in each case vs. another glucose-lowering drug or non-drug treatment, and nateglinide or repaglinide vs. each other in each case in patients with diabetes mellitus type 2.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 6, 2009

Type 2 diabetes: How do glinides compare to other medications?

There are no good-quality trials of whether glinides can prevent diabetes complications such as damage to the eyes or kidneys. It is not clear whether these blood-sugar-lowering medications have advantages for people with type 2 diabetes compared to other medications.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 10, 2011

Medicines for Type 2 Diabetes: A Review of the Research for Adults

This summary covers the research on the benefits and possible side effects of medicines to lower or control your blood sugar. It will help you talk with your doctor or other health care professional to decide which medicines are best for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: June 30, 2011

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

Given the number of medications available for type 2 diabetes mellitus, clinicians and patients need information about their effectiveness and safety to make informed choices. The objective of this review was to summarize the benefits and harms of medications (metformin, second-generation sulfonylureas, thiazolidinediones, meglitinides, dipeptidyl peptidase-4 [DPP-4] inhibitors, and glucagon-like peptide-1 [GLP-1] receptor agonists), as monotherapy and in combination, for the treatment of adults with type 2 diabetes.

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

Version: March 2011
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Second- and Third-Line Pharmacotherapy for Type 2 Diabetes: Update [Internet]

In August 2010, the Canadian Agency for Drugs and Technologies in Health (CADTH) published an Optimal Therapy Report which assessed the clinical and cost-effectiveness of second-line therapies for patients with type 2 diabetes inadequately controlled on metformin. The results from the CADTH review indicated that there were no apparent differences in efficacy across drug classes, and that sulfonylureas were the most cost-effective treatment option. Based on these analyses, the Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) Expert Review Committee (CERC) recommended that most patients requiring a second treatment after metformin should be prescribed a sulfonylurea. CADTH followed this report with a Therapeutic Review which examined the evidence for third-line treatment options for adults with type 2 diabetes inadequately controlled on metformin and a sulfonylurea. The results demonstrated that insulins (basal, biphasic, bolus), dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) analogues, and thiazolidinediones (TZDs) all produced statistically significant reductions in hemoglobin A1C in combination with metformin and a sulphonylurea. Meglitinides and alpha-glucosidase inhibitors, however, did not. The addition of insulin neutral protamine Hagedorn (NPH) to metformin plus a sulfonylurea was associated with the most favourable cost-effectiveness estimates. CADTH’s Therapeutic Review Panel (TRP) recommended that, for most adults with type 2 diabetes inadequately controlled on metformin and a sulfonylurea, insulin NPH should be added as the third-line agent. Long-acting insulin analogues at prices similar to insulin NPH were also considered an option for patients inadequately controlled on metformin and a sulfonylurea.

CADTH Optimal Use Report - Canadian Agency for Drugs and Technologies in Health.

Version: July 2013
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Drug Class Review: Newer Diabetes Medications, TZDs, and Combinations: Final Original Report [Internet]

To compare the effectiveness and adverse event profiles of amylin agonists, DPP-4 inhibitors, incretin mimetics, TZDs, and certain combination products for people with type 2 diabetes and for people with type 1 diabetes for pramlintide only.

Drug Class Reviews - Oregon Health & Science University.

Version: February 2011
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Fact sheet: Medications for the treatment of type 2 diabetes

Type 2 diabetes is a complex illness that can cause somewhat different symptoms in every individual person. For some, life will hardly have to change after the diagnosis: losing just a little weight and doing a bit more exercise is enough to get their diabetes under control. Medicines might not even come into the picture. But other people with type 2 diabetes will face lots of decisions about taking medicine.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 24, 2013

Screening for Type 2 Diabetes Mellitus: Update of 2003 Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

Diabetes poses a tremendous and increasing clinical and public health burden for Americans; 19.3 million Americans over the age of 20 years are affected, one third of whom are undiagnosed.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: June 2008
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Predictors and Consequences of Severe Hypoglycemia in Adults with Diabetes - A Systematic Review of the Evidence [Internet]

Prevalence of type 2 diabetes is increasing at an alarming pace, fueled by the rising rates of overweight and obesity in many populations. In the VA healthcare system, the prevalence of diabetes was 20% in fiscal year 2000 and is now estimated at nearly 25%.

Evidence-based Synthesis Program - Department of Veterans Affairs.

Version: April 2012
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Newer Agents for Blood Glucose Control in Type 2 Diabetes (Supplement) [Internet]

NICE issued an updated guideline (Clinical Guideline 66) for the management of all aspects of type 2 diabetes in May 2008. However new drug developments means that this guideline itself already requires an update. This technology assessment report aims to provide information to support the Short Guideline Development Group (GDG) which will produce a “new drugs update” to the 2008 guideline.

NICE Clinical Guidelines - National Institute for Health and Clinical Excellence (UK).

Version: May 2009
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Drug Class Review: Thiazolidinediones: Final Report Update 1 [Internet]

There are 2 thiazolidinediones approved for prescription use in the United States, rosiglitazone maleate (Avandia™) and pioglitazone hydrochloride (Actos®). Both drugs are approved by the United States Food and Drug Administration for use in adults for the treatment of type 2 diabetes, either as monotherapy or in combination with insulin, metformin, or sulfonylurea when diet, exercise, and a single agent does not result in adequate glycemic control. Neither drug is currently approved for use in prediabetes or the metabolic syndrome. The objective of this review was to compare thiazolidinediones in the treatment of type 2 diabetes, prediabetes, and the metabolic syndrome.

Drug Class Reviews - Oregon Health & Science University.

Version: August 2008
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Meglitinide analogues for type 2 diabetes mellitus

In type 2 diabetes mellitus, impairment of insulin secretion is an important component of the disease. The meglitinide analogues ("meglitinides") are a class of oral antidiabetic agents that increase insulin secretion in the pancreas. The properties of this class of drug suggest that they have the potential to produce a rapid, short‐lived insulin output. Two analogues are currently available for clinical use: repaglinide and nateglinide. Altogether 15 studies were included in this review, eight of the studies used repaglinide as the study drug and five used nateglinide. Two compared the two meglitinides to one another. In total, 3781 people participated in the 15 studies which mainly lasted between 10 and 24 weeks (one study had a duration of 52 weeks).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

The effects of oral anti-hyperglycaemic medications on serum lipid profiles in patients with type 2 diabetes

AIM: Patients with type 2 diabetes often have dyslipidaemia, putting them at risk of cardiovascular disease, and are frequently treated with oral anti-hyperglycaemic medications (OAMs). This review compares the effects of OAMs on serum lipids [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TGs) and free fatty acids (FFAs)] in patients with type 2 diabetes.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Comparison of the hypoglycemic effect of acarbose monotherapy in patients with type 2 diabetes mellitus consuming an Eastern or Western diet: a systematic meta-analysis

BACKGROUND: Because of its mechanism of action, the starch content of a diet might alter the hypoglycemic effect of acarbose.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Diabetes in Pregnancy: Management of Diabetes and Its Complications from Preconception to the Postnatal Period

This clinical guideline contains recommendations for the management of diabetes and its complications in women who wish to conceive and those who are already pregnant. The guideline builds on existing clinical guidelines for routine care during the antenatal, intrapartum and postnatal periods. It focuses on areas where additional or different care should be offered to women with diabetes and their newborn babies.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: March 2008
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Comparing Medications for Adults With Type 2 Diabetes

A systematic review of 166 clinical studies published between January 1966 and April 2010 examined the comparative effectiveness, benefits, and adverse effects of available monotherapy and two-drug combinations of medications for adults with type 2 diabetes (see list of type 2 diabetes medications studied). The review did not cover treatment of type 1 diabetes or gestational diabetes nor does it review evidence regarding the effectiveness of diet, exercise, and weight loss. The full report, listing all studies, is available at http://www.effectivehealthcare.ahrq.gov/diabetesmeds.cfm. This summary, based on the full report of research evidence, is provided to inform discussions with patients of options and to assist in decisionmaking along with consideration of a patient’s values and preferences. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

Comparative Effectiveness Review Summary Guides for Clinicians [Internet] - Agency for Healthcare Research and Quality (US).

Version: June 30, 2011

Interventions To Improve Cardiovascular Risk Factors in People With Serious Mental Illness [Internet]

Individuals with serious mental illness (SMI) have excess mortality from cardiovascular disease (CVD) and high rates of CVD risk factors such as diabetes, obesity, and hyperlipidemia. We conducted a systematic review to evaluate interventions to improve CVD risk factors in adults with SMI.

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

Version: April 2013
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Bariatric Surgery and Nonsurgical Therapy in Adults With Metabolic Conditions and a Body Mass Index of 30.0 to 34.9 kg/m2 [Internet]

To systematically review the scientific evidence on efficacy, safety, and comparative effectiveness of various types of bariatric surgery for treating adult patients with a body mass index (BMI) of 30.0 to 34.9 kg/m2 and diabetes or impaired glucose tolerance (IGT) and to compare effectiveness of surgery versus nonsurgical interventions in this population.

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

Version: June 2013
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Screening for Cystic Fibrosis-Related Diabetes: A Systematic Review

Cystic fibrosis (CF) is an inherited disease that leads to damage to lungs, pancreas and other organs. Most people with CF die prematurely from lung disease, but survival has improved markedly over the decades and it is estimated that children born with CF now will live to an average age of 50 years. CF-related diabetes (CFRD) is due to damage to the pancreas, which, over time, loses its capacity to produce sufficient insulin. CFRD is becoming more common owing to the improved survival of people with CF.

Health Technology Assessment - NIHR Evaluation, Trials and Studies Coordinating Centre (UK).

Version: May 2012
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