Effects Of Oral Antidiabetic Medication On Reducing Cerebrovascular Risk In Patients With Type 2 Diabetes Mellitus: A Meta-analysis

BackgroundA wide variety of oral antidiabetic medications are currently available for the treatment of type 2 diabetes mellitus (T2DM). But it is unclear what role that the different oral antidiabetic medications played in reducing cerebrovascular accidents.AimWe aimed at reviewing the peer-reviewed literatures to compare the effects of different oral antidiabetic agents (meglitinides, sulfonylureas, glucagon-like peptide-1, dipeptidylpeptidase-4 inhabitors, thiazolidinediones, biguanides, a-glucosidase inhibitor, amylin analog) in reducing cerebrovascular morbidity in adults with type 2 diabetes mellitus.Object and MethodsData sources were MEDLINE(?), EMBASE(?), and the Cochrane Central Register of Controlled Trials, from inception through October 2010. Using standardized protocols,2 reviewers serially abstracted data for each article. Randomized Controlled Trials (RCTs) for published meta-analysis in people with T2DM comparing oral antidiabetic agents (meglitinides, sulfonylureas, glucagon-like peptide-1, dipeptidylpeptidase-4 inhabitors, thiazolidinediones, biguanides,a-glucosidase inhibitor, amylin analog) with other treatments (placebo, active comparators) were selected. Proportions of outcome measures across treatment groups were compared by odds ratios (ORs) and 95% confidence interval.Results Ten publications of controlled trials and three published meta-analysis that reported information on morbidity of cerebrovascular accidents (stroke, excluding TIA) were retrieved. All the selected publications were respect to four kinds of antidiabetes medicines, sulfonylureas, dipeptidylpeptidase-4 inhabitors, thiazolidinediones, and biguanides, which were widely used and available as a generic in clinical practice. Compared to any other agent or placebo, sulfonylurea was the only diabetes agent associated with a decrease risk of cerebrovascular morbidity, but this result was not statistically significant (OR 0.85 95% CI 0.54 to 1.35). A small increased risk was seen in patients receiving TZDs (OR 1.06 95% CI 0.68 to 1.65), pioglitazone (OR 1.1095% CI 0.54 to 2.23), and any DDP-4(OR 1.01 95% CI 0.57 to 1.77). And, sulfonylurea seemed more beneficial than TZD on reducing stroke (OR 0.87 95% CI 0.53 to 1.44). However, none of these estimates were statistically significant.ConclusionsCompared to other oral diabetes agents and placebo, sulfonylurea may have more beneficial effects on reducing cerebrovascular than other kinds of antidiabetes medications, although it is lack of power prohibited firmer conclusions. Larger, long-term studies taken to hard endpoints and better reporting of cerebrovascular accidents in short term studies will be required to draw firm conclusions about major clinical benefits and risks related to oral diabetes agents.