Endocrine

, Volume 44, Issue 3, pp 648–658

The effects of sulfonylureas plus metformin on lipids, blood pressure, and adverse events in type 2 diabetes: a meta-analysis of randomized controlled trials

  • Fan Zhang
  • Hao Xiang
  • Yunzhou Fan
  • Tsend-ayush Ganchuluun
  • Wenhua Kong
  • Qian Ouyang
  • Jingwen Sun
  • Beibei Cao
  • Hongbo Jiang
  • Shaofa Nie
Meta-Analysis

DOI: 10.1007/s12020-013-9970-6

Cite this article as:
Zhang, F., Xiang, H., Fan, Y. et al. Endocrine (2013) 44: 648. doi:10.1007/s12020-013-9970-6

Abstract

To compare the effects of sulfonylureas and metformin versus metformin on lipid profiles, blood pressure, and adverse events. PubMed, EMbase, Chinese BioMedical Literature on disc, China National Knowledge Infrastructure, VIP database, and Wanfang database were searched for randomized controlled trials (RCTs), from inception to August 2012. Key outcomes were low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), total cholesterol (TC), blood pressure (BP), hemoglobin A1c (HbA1c), fasting insulin, and adverse events. Twenty RCTs were included in the analysis. Compared to metformin, the combination therapy of sulfonylureas and metformin slightly reduced HDL-C [−0.03, 95 % CI (−0.06, −0.01)] and HbA1c (−0.79, 95 % CI −0.96 to −0.63). However, it showed little effects on LDL-C, TG, TC, and BP. Glipizide plus metformin significantly increased fasting insulin [2.33, 95 % CI (1.94, 2.73)]. Hypoglycemia and nervous system side events were more frequent among patients treated with sulfonylureas plus metformin than metformin alone (RR = 6.79, 95 % CI 3.79–12.17; RR = 1.27, 95 % CI 1.03–1.57; respectively), but less in digestive symptoms (RR = 0.75, 95 % CI 0.67–0.84). Combination therapy with sulfonylureas and metformin may be more effective than metformin alone in improving HbA1c and reducing gastrointestinal reactions. But it had disadvantage of decreasing HDL-C, increasing the risk of hypoglycemia and nervous system side events.

Keywords

Metformin  Sulfonylureas  Type 2 diabetes  Blood pressure  Cholesterol  Meta-analysis 

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Fan Zhang
    • 1
  • Hao Xiang
    • 2
    • 3
  • Yunzhou Fan
    • 1
  • Tsend-ayush Ganchuluun
    • 1
  • Wenhua Kong
    • 1
  • Qian Ouyang
    • 1
  • Jingwen Sun
    • 1
  • Beibei Cao
    • 1
  • Hongbo Jiang
    • 1
  • Shaofa Nie
    • 1
  1. 1.Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
  2. 2.School of Public HealthWuhan UniversityWuhanChina
  3. 3.Wuhan University Global Health InstituteWuhanChina