Summary: | Pharmacologic treatment of type 2 diabetes following the failure of conventional diet and exercise interventions begins with metformin (except where contraindicated). Inadequate glycemic control with metformin is common. Treatment algorithms recommend the addition of oral or injectable antidiabetic drugs or insulin to metformin as a next step (second-line therapy). Previous CADTH reports (2013) on second-line therapy provided comparative efficacy and cost-effectiveness recommendations. Since then, a new drug class has entered the Canadian market for the treatment of patients with type 2 diabetes -- sodium-glucose cotransporter-2 (SGLT-2) inhibitors. In addition, a fourth dipeptidyl peptidase-4 (DPP-4) inhibitor (alogliptin) as well as a third glucagon-like peptide-1 (GLP-1) analogue (dulaglutide) have appeared on the Canadian market, and new data on the impact on cardiovascular outcomes of some of the new drugs (e.g., GLP-1 agonists, DDP-4 inhibitors, and SGLT-2 inhibitors) have been published recently. As a result, there is a need to reassess the comparative efficacy, safety, and cost-effectiveness of the available drug classes for the treatment of patients with type 2 diabetes
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