title: The effects of sulfonylureas plus metformin on lipids, blood pressure, and adverse events in type 2 diabetes: a meta-analysis of randomized controlled trials.
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.
authors: Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China.
authors: Fan
authors: F
authors: Zhang
authors: Hao
authors: H
authors: Xiang
authors: Yunzhou
authors: Y
authors: Fan
authors: Tsend-Ayush
authors: TA
authors: Ganchuluun
authors: Wenhua
authors: W
authors: Kong
authors: Qian
authors: Q
authors: Ouyang
authors: Jingwen
authors: J
authors: Sun
authors: Beibei
authors: B
authors: Cao
authors: Hongbo
authors: H
authors: Jiang
authors: Shaofa
authors: S
authors: Nie
mesh_terms: D001794:Blood Pressure / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood*; D008687:Metformin / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D007004:Hypoglycemic Agents; D008055:Lipids; D013453:Sulfonylurea Compounds; D008687:Metformin
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