Evidence map›Paper›PMID 38872216›Full record

ArticleSystematic reviews2024

The optimal second-line therapy for older adults with type 2 diabetes mellitus: protocol for a systematic review and network meta-analysis using individual participant data (IPD).

Jingya Wang, Krishnarajah Nirantharakumar, Christopher Sainsbury, David J Moore, Alan Sinclair, G Neil Thomas, Wasim Hanif, Megha Singh, Luyuan Tan, Zhaonan Wang and 8 more

Abstract read
In one paragraph

Article in Systematic reviews, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–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

1 citing paper in PubMed.

  1. 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

18 authors.

Jingya WangInstitute of Applied Health Research, University of Birmingham, Birmingham, UK. J.Wang.6@bham.ac.uk.ORCID 0000-0003-1498-2693
Krishnarajah NirantharakumarInstitute of Applied Health Research, University of Birmingham, Birmingham, UK.
Christopher SainsburyInstitute of Applied Health Research, University of Birmingham, Birmingham, UK.
David J MooreInstitute of Applied Health Research, University of Birmingham, Birmingham, UK.
Alan SinclairFoundation for Diabetes Research in Older People, King's College London, London, UK.
G Neil ThomasInstitute of Applied Health Research, University of Birmingham, Birmingham, UK.
Wasim HanifDepartment of Diabetes and Endocrinology, University Hospital Birmingham, Birmingham, UK.
Megha SinghInstitute of Applied Health Research, University of Birmingham, Birmingham, UK.
Luyuan TanInstitute of Applied Health Research, University of Birmingham, Birmingham, UK.
Zhaonan WangInstitute of Applied Health Research, University of Birmingham, Birmingham, UK.
Nikita Simms-WilliamsInstitute of Applied Health Research, University of Birmingham, Birmingham, UK.
Mi YaoDepartment of General Practice, Peking University First Hospital, Beijing, China.
M Niluka GunathilakaInstitute of Applied Health Research, University of Birmingham, Birmingham, UK.
Pushpa SinghDepartment of Diabetes and Endocrinology, University Hospital Birmingham, Birmingham, UK.
Konstantinos ToulisInstitute of Applied Health Research, University of Birmingham, Birmingham, UK.
Apostolos TsapasDiabetes Centre, Second Medical Department, Ippokratio General Hospital, Thessaloniki, Greece.
Dyuti CoomarInstitute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
Malcolm James PriceInstitute of Applied Health Research, University of Birmingham, Birmingham, UK. m.price.2@bham.ac.uk.

Funding

National Institute for Health Research Health Protection Research Unit NIHR200796
6 · The paper itself

Abstract

backgroundDue to increasing life expectancy, almost half of people with type 2 diabetes are aged 65 years or over worldwide. When metformin alone does not control blood sugar, the choice of which second-line therapy to prescribe next is not clear from currently available evidence. The existence of frailty and comorbidities in older adults further increases the complexity of medical decision-making. As only a relatively small proportion of trials report results separately for older adults, the relative efficacy and safety of second-line therapies in older adults with type 2 diabetes mellitus are unknown and require further investigation. This individual participant data (IPD) network meta-analysis evaluates the relative efficacy and safety of second-line therapies on their own or in combination in older adults with type 2 diabetes mellitus.

methodsAll relevant published and unpublished trials will be identified. Studies published prior to 2015 will be identified from two previous comprehensive aggregate data network meta-analyses. Searches will be conducted in CENTRAL, MEDLINE, and EMBASE from 1st January 2015 onwards, and in clinicaltrials.gov from inception. Randomised controlled trials with at least 100 estimated older adults (≥ 65 years) receiving at least 24 weeks of intervention that assess the effects of glucose-lowering drugs on mortality, glycemia, vascular and other comorbidities outcomes, and quality of life will be eligible. The screening and data extraction process will be conducted independently by two researchers. The quality of studies will be assessed using the Cochrane risk of bias tool 2. Anonymised IPD of all eligible trials will be requested via clinical trial portals or by contacting the principal investigators or sponsors. Received data will be reanalysed where necessary to standardise outcome metrics. Network meta-analyses will be performed to determine the relative effectiveness of therapies. DISCUSSION: With the increasing number of older adults with type 2 diabetes worldwide, an IPD network meta-analysis using data from all eligible trials will provide new insights into the optimal choices of second-line antidiabetic drugs to improve patient management and reduce unnecessary adverse events and the subsequent risk of comorbidities in older adults. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021272686.

Indexed as

Diabetes Mellitus, Type 2Hypoglycemic AgentsSystematic Reviews as TopicAgedHumansMetforminNetwork Meta-Analysis as TopicResearch DesignHypoglycemic AgentsMetforminBiguanideDipeptidyl peptidase-4 inhibitorsGlucagon-like peptide-1 agonistsGlucose-lowering agentsInsulinMetforminRandomised controlled trialsSodium-glucose cotransporter-2 inhibitorsSulfonylureasThiazolidinediones

Identifiers

PMID38872216
PMCPMC11170882

What OpenQuestion holds

Texttitle and abstract
LicenceCC BY
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.