Evidence-informed recommendations were developed by the Canadian Drug Expert Committee (CDEC) to address the following policy questions:

1. What is the optimal second-line therapy for patients with type 2 diabetes experiencing inadequate glycemic control with metformin monotherapy?
2. What is the optimal third-line therapy for patients with type 2 diabetes experiencing inadequate glycemic control with metformin and a sulfonylurea?
3. If insulin continues to be the recommended third-line therapy for most patients, what alternative(s) are recommended for patients unable to use insulin?
4. What is the role, if any, for the combined use of insulins and incretin agents in patients with type 2 diabetes?

Contents

• ABBREVIATIONS
• 1. BACKGROUND
• 2. POLICY AND RESEARCH QUESTIONS
  • 2.1 Policy Questions
  • 2.2 Research Questions
• 3. SUMMARY OF RECOMMENDATIONS
• 4. RECOMMENDATIONS
• 5. SUMMARY OF THE EVIDENCE
  • 5.1 Review of Second-Line Pharmacotherapy
  • 5.2 Review of Third-Line Pharmacotherapy
  • 5.3 Review of Combination Use of Incretin Drugs and Insulin
• 6. DISCUSSION POINTS
  • 6.1 Second-Line and Third-Line Pharmacotherapy
  • 6.2 Combination Use of Incretin Drugs and Insulin
• 7. RESEARCH GAPS
  • 7.1 Second-Line and Third-Line Pharmacotherapy
  • 7.2 Combination Use of Incretin Drugs and Insulin
• REFERENCES

Members of the Canadian Drug Expert Committee: Dr. Robert Peterson (Chair), Dr. Lindsay Nicolle (Vice-Chair), Dr. Ahmed Bayoumi,Dr. Bruce Carleton, Ms. Cate Dobhran, Mr. Frank Gavin, Dr. John Hawboldt,Dr. Peter Jamieson, Dr. Julia Lowe, Dr. Kerry Mansell, Dr. Irvin Mayers,Dr. James Silvius, and Dr. Adil Virani

Regrets: Two CDEC members were unable to attend the meeting.

Conflicts of Interest: None

Other participants: An external Clinical Expert attended the meeting and participated in the discussion but did not vote on the recommendations.

Suggested citation:

Canadian Agency for Drugs and Technologies in Health. Optimal use recommendations for second and third-line therapy for patients with type 2 diabetes. Ottawa: The Agency; 2013. (CADTH optimal use report; vol.3, no. 1d).

This report is prepared by the Canadian Agency for Drugs and Technologies in Health (CADTH). The report contains a comprehensive review of the existing public literature, studies, materials, and other information and documentation (collectively the “source documentation”) available to CADTH at the time of report preparation.

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