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Meta-Analysis
. 2005 Sep 15;36(4):183-91.
doi: 10.1157/13078602.

[Metformin for type-2 diabetes mellitus. Systematic review and meta-analysis]

[Article in Spanish]
A Sáenz Calvo  1 , I Fernández Esteban, A Mataix Sanjuán, M Ausejo Segura, M Roqué, D Moher
Affiliations
Meta-Analysis

[Metformin for type-2 diabetes mellitus. Systematic review and meta-analysis]

[Article in Spanish]
A Sáenz Calvo et al. Aten Primaria. .

Abstract
in English, Spanish

Objective: To evaluate the efficacy of metformin against placebo, diet, oral anti-diabetics, or insulin in type 2 diabetes mellitus.

Design: Systematic review.

Data sources: MEDLINE (1966-2003), EMBASE (1974-2003), LILACS (1986-2003), Cochrane library (Issue 3, 2003).

Selection of studies: 29 randomized clinical trials of metformin in monotherapy, with results on mortality, morbidity, and biochemistry. EXTRACTION OF DATA: RevMan 4 computer program. Two reviewers extracted the data and evaluated the quality.

Main variables: any clinical event related to diabetes (mortality, coronary disease, stroke, arterial disease, and retinopathy). Secondary variables: weight and biochemistry.

Results: 29 clinical studies with 37 comparisons of metformin were analyzed (13 with sulphonylureas, 12 with placebo, 3 with diet, 3 with thiazolidinediones, 2 with alpha-glucosidase inhibitors, 2 with insulin, and 2 with meglitinides). Metformin was more beneficial than the sulphonylureas or insulin for any clinical event associated with diabetes (relative risk [RR]=0.78; 95% confidence interval [CI], 0.65-0.94) and than diet (RR=0.74; 95% CI, 0.60-0.90). Metformin decreased glycosylated hemoglobin A1 (weighted mean difference, -1.21%; 95% CI, -1.48 to -0.94), low density lipoprotein cholesterol (weighted mean difference, -0.24; 95% CI, -0.40 to -0.09), and weight (standardized mean difference, -0.11; 95% CI, -0.18 to -0.04). Metformin was more beneficial than the placebo, diet or the thiazolidinediones on glycosylated hemoglobin A1, and than the sulphonylureas or insulin on weight.

Conclusions: In the long term metformin reduces the risks of clinical events associated with diabetes. There are no long term clinical trials which compare alpha-glucosidase inhibitors, meglitinides, and thiazolidinediones with metformin, in primary results. The different treatments compared with metformin did not obtain more benefit for the secondary results evaluated.

Objetivo: Evaluar la eficacia de la metformina frente a placebo, dieta, antidiabéticos orales o insulina en la diabetes mellitus tipo 2.

Diseño: Revisión sistemática.

Fuentes de datos: MEDLINE (1966-2003), EMBASE (1974-2003), LILACS (1986-2003), Cochrane library (Issue 3, 2003).

Selección de estudios: Se seleccionaron 29 ensayos clínicos aleatorizados de metformina en monoterapia, con resultados sobre mortalidad, morbilidad y bioquímica.

Extracción de datos: Programa informático RevMan 4. Dos revisores extrajeron los datos y evaluaron la calidad. Variables principales: cualquier acontecimiento clínico relacionado con la diabetes (mortalidad, coronariopatía, ictus, nefropatía, arteriopatía y retinopatía). Variables secundarias: peso y bioquímica.

Resultados: Se analizaron 29 ensayos clínicos con 37 comparaciones de metformina (13 con sulfonilureas, 12 con placebo, 3 con dieta, 3 con tiazolidindionas, 2 con inhibidores de la α-glucosidasa, 2 con insulina y 2 con meglitinidas). La metformina mostró mayor beneficio que las sulfonilureas o la insulina para cualquier acontecimiento clínico relacionado con la diabetes (riesgo relativo = 0,78; intervalo de confianza [IC] del 95%, 0,65 a 0,94) y que la dieta (riesgo relativo = 0,74; IC del 95%, 0,60 a 0,90). La metformina disminuyó la hemoglobina A1 glucosilada (diferencia media ponderada: −1,21%; IC del 95%, −1,48 a −0,94), colesterol unido a lipoproteínas de baja densidad (diferencia media ponderada: −0,24; IC del 95%, −0,40 a −0,09) y peso (diferencia media estandarizada: −0,11; IC del 95%, −0,18 a −0,04). La metformina presentó mayor beneficio que el placebo, la dieta o las tiazolidindionas en la hemoglobina A1 glucosilada, y que las sulfonilureas o la insulina en el peso.

Conclusiones: A largo plazo la metformina disminuye el riesgo de acontecimientos clínicos relacionados con la diabetes. No existen ensayos clínicos a largo plazo que comparen con metformina los inhibidores de la α-glucosidasa, meglitinidas y tiazolidindionas, en resultados primarios. Las diferentes intervenciones comparadas con metformina no obtuvieron más beneficio para los resulta dos secundarios evaluados.

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Comment in

  • [The rehabilitation of metformin].
    Fernández Fernández I. Fernández Fernández I. Aten Primaria. 2005 Sep 15;36(4):192-3. doi: 10.1157/13078604. Aten Primaria. 2005. PMID: 16153371 Free PMC article. Spanish. No abstract available.

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