Evidence map›Paper›PMID 25147257›Full record

ArticleDiabetes care2014

Beyond metformin: safety considerations in the decision-making process for selecting a second medication for type 2 diabetes management: reflections from a diabetes care editors' expert forum.

William T Cefalu, John B Buse, Stefano Del Prato, Philip D Home, Derek LeRoith, Michael A Nauck, Itamar Raz, Julio Rosenstock, Matthew C Riddle

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Diabetes care, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
27citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

27 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
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  14. IDegLira Versus Insulin Glargine U100: A Long-term Cost-effectiveness Analysis in the US Setting.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2017
    Article
  15. Review
  16. Observational
  17. Article
  18. Long-term management of type 2 diabetes with glucagon-like peptide-1 receptor agonists.Diabetes, metabolic syndrome and obesity : targets and therapy · 2017
    Review
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  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

William T CefaluPennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA william.cefalu@pbrc.edu.
John B BuseUniversity of North Carolina School of Medicine, Chapel Hill, NC.
Stefano Del PratoDepartment of Clinical and Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy.
Philip D HomeNewcastle University, Newcastle upon Tyne, U.K.
Derek LeRoithIcahn School of Medicine at Mt. Sinai, New York, NY.
Michael A NauckDiabeteszentrum Bad Lauterberg, Bad Lauterberg, Germany.
Itamar RazDiabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel.
Julio RosenstockDallas Diabetes and Endocrine Center at Medical City and University of Texas Southwestern Medical Center, Dallas, TX.
Matthew C RiddleDivision of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health & Science University, Portland, OR.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The trend toward personalized management of diabetes has focused attention on the differences among available pharmacological agents in terms of mechanisms of action, efficacy, and, most important, safety. Clinicians must select from these features to develop individualized therapy regimens. In June 2013, a nine-member Diabetes Care Editors' Expert Forum convened to review safety evidence for six major diabetes drug classes: insulin, sulfonylureas (SUs), thiazolidinediones (TZDs), glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, and sodium glucose cotransporter 2 inhibitors. This article, an outgrowth of the forum, summarizes well-delineated and theoretical safety concerns related to these drug classes, as well as the panelists' opinions regarding their best use in patients with type 2 diabetes. All of the options appear to have reasonably wide safety margins when used appropriately. Those about which we know the most-metformin, SUs, insulin, and perhaps now also TZDs-are efficacious in most patients and can be placed into a basic initial algorithm. However, these agents leave some clinical needs unmet. Selecting next steps is a more formidable process involving newer agents that are understood less well and for which there are unresolved questions regarding risk versus benefit in certain populations. Choosing a specific agent is not as important as implementing some form of early intervention and advancing rapidly to some form of combination therapy as needed. When all options are relatively safe given the benefits they confer, therapeutic decision making must rely on a personalized approach, taking into account patients' clinical circumstances, phenotype, pathophysiological defects, preferences, abilities, and costs.

Indexed as

Patient-Centered CareDiabetes Mellitus, Type 2Dipeptidyl-Peptidase IV InhibitorsDisease ManagementExpert TestimonyGlucagon-Like Peptide-1 ReceptorHumansHypoglycemic AgentsInsulinMetforminReceptors, GlucagonSulfonylurea CompoundsThiazolidinedionesDipeptidyl-Peptidase IV InhibitorsGLP1R protein, humanGlucagon-Like Peptide-1 ReceptorHypoglycemic AgentsInsulinMetforminReceptors, GlucagonSulfonylurea CompoundsThiazolidinediones

Identifiers

PMID25147257
PMCPMC5169170

What OpenQuestion holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.