Condition

Type 2 diabetes is a chronic disease that results when the pancreas does not produce enough insulin, or the body does not properly use the insulin that it makes.

Drugs

The treatment of patients with type 2 diabetes usually begins with lifestyle modifications, followed by treatment with oral antidiabetes drugs. Metformin is typically used as the first-line oral drug in most patients. Other medication classes currently available for the treatment of type 2 diabetes include: sulfonylureas, meglitinides, alpha-glucosidase inhibitors, thiazolidinediones (TZDs), dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) analogues, and insulins.

Issues

Given that type 2 diabetes is a progressive disease, most patients will eventually require additional antidiabetes drugs. However, current guidelines do not provide specific guidance on the optimal treatment algorithm when metformin is no longer adequate to achieve glycemic control. Also, there is considerable variability in the costs of diabetes treatments, and expenditures in Canada are rising.

In 2010, CADTH issued recommendations for the optimal choice of second- and third-line drugs after metformin for patients with type 2 diabetes. Since then, new antidiabetes treatments have been approved for use in Canada.

Methods

CADTH updated its earlier systematic reviews of clinical evidence and performed an updated cost-effectiveness analysis. Based on the results, an expert panel updated CADTH’s 2010 recommendations.

Research Results

The results of the updated clinical and economic evaluations remained similar to those of the original analyses: glycemic control was similar across most drug classes, there were some differences in the risk of weight gain and hypoglycemia, and sulfonylureas and insulin NPH were the most cost-effective options for second- and third-line therapy, respectively.

For the full reports and tools, visit www.cadth.ca/t2dm.

DISCLAIMER: The information in this Project in Brief is intended to help health care decision‐makers, patients, health care professionals, health systems leaders, and policy‐makers make well‐informed decisions and thereby improve the quality of health care services. The information in this Project in Brief should not be used as a substitute for the application of clinical judgment in respect of the care of a particular patient or other professional judgment in any decision‐making process nor is it intended to replace professional medical advice. While CADTH has taken care in the preparation of the Project in Brief to ensure that its contents are accurate, complete, and up‐to‐date, CADTH does not make any guarantee to that effect. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or as a result of the use (or misuse) of any information contained in or implied by the information in this Project in Brief.

CADTH takes sole responsibility for the final form and content of this Project in Brief. The statements, conclusions, and views expressed herein do not necessarily represent the view of Health Canada or any provincial or territorial government. Production of this Project in Brief is made possible through a financial contribution from Health Canada.