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Pooled review (meta-analysis)

Pooled review of 204 studies: fewer heart deaths with metformin, little clear evidence otherwise

Maruthur and colleagues · Annals of internal medicine · 2016

Original title: Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes: A Systematic Review and Meta-analysis.

Under review. A person has not yet checked this summary against the paper. It is written from the PubMed abstract. Until a person checks it, search engines are asked not to list this page.

What the study found

Mixed

Cardiovascular death was lower with metformin than with sulfonylureas. Evidence on all-cause death, heart events and small-vessel complications was insufficient or of low strength.

The study at a glance

Type of study
Pooled review (meta-analysis)
Who or what was studied
204 studies · Adults with type 2 diabetes
What was tested
Diabetes drugs alone or with metformin, compared head to head (179 trials, 25 observational studies)
What it measured
Several kinds of outcomes
Who has a stake
No disclosure in PubMed
No disclosure in PubMed. Funded by the Agency for Healthcare Research and Quality.
Journal
Annals of internal medicine, 2016
Source
PubMed record 27088241. This page is based on the abstract only.

How much this study counts

  • ✓Pools the results of 204 studies.
  • •A pooled review is only as strong as the studies it pools.
  • •Measured several kinds of outcomes.
  • •The PubMed record has no conflict-of-interest statement.
  • •Summarized from the PubMed abstract only. The full paper may hold details the abstract leaves out.

✓ Strength– Limit• Note

These points come from fixed rules about the type of study, its size and length, what it measured, and who has a stake. Every study on Digestery gets the same rules.

Where this study sits

This paper is not on the ladder. It is a pooled review (meta-analysis), and reviews and opinion pieces discuss studies that are already counted on the steps below.

↑ Stronger evidence

  1. Trials in people: aging and age-related disease

    1

    1 benefit

  2. Trials in people: other measures

    3

    2 no difference, 1 harm

  3. Trials in people: lab tests or safety

    6

    2 benefit, 2 mixed, 2 no difference

  4. Population studies

    8

    6 benefit, 2 no difference

  5. Blood levels and genes

    0

    None among the papers we read.

  6. Animals

    3

    2 benefit, 1 harm

↓ Weaker evidence

  • Points to benefit
  • Mixed
  • No difference
  • No direction
  • Points to harm

How it fits with the other research

The short answer to “Does metformin slow aging in people without diabetes?”

Not shown in people without diabetes.

Confidence: low. Based on 26 on-topic papers.

Read the full answer
  • Summed up in “What reviews found”: Pooled 179 trials and 25 observational studies of diabetes drugs in adults with type 2 diabetes. Heart-related death was lower with metformin than with sulfonylureas. Evidence on death from any cause was insufficient or of low strength.

Other reviews on this question

See all 26 studies on this question

How this page was made

Label

First read of the abstract
Claude Sonnet
Independent second read
Claude Haiku
Differences settled
The two reads differed. The reviewer checked the abstract and kept the first read. Claude Opus 5.5.
Headline
Claude Sonnet, from the checked study record. A script checked its numbers and wording.
Numbers
Checked against the abstract by a script
“How much this study counts”
Fixed rules, the same for every study
Source check by a person
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