Monami et al evaluated changes in lipid levels with GLP-1RA versus placebo inside a meta-analysis.28 This analysis was based on four trials reporting change in total cholesterol and high-density lipoprotein and five trials reporting change in triglycerides. US will develop type Dexamethasone 2 diabetes mellitus (T2DM) in their lifetime.1 T2DM is a progressive disorder characterized by insulin resistance and a progressive insulin secretory defect.2 Diabetes is the seventh leading cause of death in the US and associated with severe Dexamethasone microvascular and macrovascular complications.1 Glycemic control reduces the risk for diabetes-related morbidity and mortality.2 In order to control glucose levels as the disease progresses, individuals require lifestyle changes, dietary modifications, exercise, excess weight loss, and pharmacologic treatment, often with multiple classes of diabetes medications.2 Metformin (MET) is recommended while the first-line treatment for individuals with T2DM due to well-established efficacy, security, low cost, and data demonstrating a reduction in risk of cardiovascular (CV) events.2 However, controversy is present regarding the selection of second-line treatment in individuals optimized on MET but not achieving glycemic focuses on, with contraindications to use of MET, or unable to tolerate MET.2,3 Pharmacologic options for the treatment of T2DM have expanded over the last decade. Second-line treatments include basal insulin, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RA), sodiumCglucose cotransporter 2 inhibitors (SGLT2-I), sulfonylureas (SU), or thiazolidinediones (TZD).2 The American Diabetes Association 2016 guideline details a number of second-line options for use following MET and does not give preference to one drug class on the additional.2 The American Association of Clinical Endocrinologists and American College of Endocrinology 2015 guideline does, however, give preference to GLP-1RA and SGLT2-I over older medication classes including SU and TZD.3 Both the American Diabetes Association and the American Association of Clinical Endocrinologists and American College of Endocrinology recommend that a patient-centered approach should guidebook the selection of pharmacologic providers.2,3 Considerations may include efficacy, cost, potential adverse effects, excess weight consideration, comorbid medication conditions, risk of hypoglycemia, and patient preferences.2 Two newer pharmacologic classes, GLP-1RA and SGLT2-I, in particular display promise as second-line treatment options given their favorable effects on excess weight and low potential for hypoglycemia. No head-to-head tests comparing providers in these two classes are currently available to guidebook decision-making. The purpose of this evaluate Dexamethasone is to compare the medical trial and real-world performance data of second-line therapy with SGLT2-I and GLP-1RA related to A1c reduction, excess weight loss, cost-effectiveness, and security in individuals with T2DM. Therefore, this review will summarize comparative evidence for companies who are considering which of the two classes might be the most appropriate for a specific patient. Methods A Medline search was performed in August 2015 to identify clinical tests and observational studies related to SGLT2-I and GLP-1RA for the treatment of T2DM. Content articles included data from human being studies published within the past 10 years evaluating A1c, excess weight, or CV results, and/or reporting adverse drug event (ADE) data versus placebo or versus additional classes of interest. MeSH terms looked included SGLT2 or sodium glucose transport proteins, GLP-1 or glucagon-like peptides, and T2DM. Included content articles were limited to evaluations of GLP-1RA or SGLT2-I versus placebo, with or without background MET therapy. In the case of content articles comprising multiple arms including comparisons to additional treatments for T2DM, only the arm meeting inclusion criteria is definitely presented due to the scope of this review. Content articles on GLP-1RA or SGLT2-I used in combination with therapies other than MET were excluded. Articles evaluating liraglutide (Saxenda), which is definitely US Food and Drug Administration (FDA) authorized for weight management in individuals with or without diabetes, were also excluded. Results As explained in Numbers 1 and ?and2,2, a total of 2,232 content articles were found in an initial Medline search, of which 846 content articles were regarding GLP-1RA and 1,386 content articles were related to SGLT2-I. Duplicate content articles were eliminated and the remaining content articles were screened for results for comparisons of Dexamethasone interest. Following our initial search, we recognized five additional content articles which met our inclusion criteria, bringing the total to 46 studies which were included in this review. Articles were reviewed for effectiveness at reducing A1c (Furniture 1 and ?and2)2) or for additional medical effects including effect on excess weight, blood pressure (BP), or additional drug-related outcomes. Open in a separate Dexamethasone window Number1 Circulation diagram of GLP-1 study selection. Abbreviations: GLP-1RA, glucagon-like peptide-1 receptor agonists; RCT, randomized controlled trial; GLP-1, glucagon-like peptide-1. Open in a separate window Number 2 Circulation diagram of SGLT2-I study selection. Abbreviations: SGLT2-I, sodiumCglucose cotransporter 2 inhibitors; RCT, randomized controlled trial; Table 1 Mean A1c reduction in clinical E2F1 studies of GLP-1RA thead th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ Study /th th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ Period (weeks) /th th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ Baseline A1c (%) /th th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ Treatment /th th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ Mean switch in A1c (%) /th /thead Nauck et al21268.4LIRA 1.8 mg.