Metformin extended-release versus metformin immediate-release for adults with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials
Abstract
AIM
To compare the efficacy and tolerability metformin extended-release (MXR) and the conventional metformin immediate-release (MIR) in adults with type 2 diabetes mellitus (T2DM) METHODS: PubMed, the Cochrane Library, ClinicalTrials.gov and other sources were searched for randomized controlled trials (RCTs) that compared equal daily doses of MXR and MIR in adults with T2DM from platform inception to 19 March 2021. Random-effects model meta-analysis was performed to obtain, with 95% confidence intervals (CIs), pooled mean difference (MD) of change from baseline for continuous outcomes and risk ratio (RR) for dichotomous outcomes. Primary outcomes were HbA1c and key gastrointestinal (GI) symptoms (abdominal discomfort or pain, diarrhea, dyspepsia, and nausea & vomiting); fasting and post-prandial plasma glucose, other GI and serious adverse events (AEs), serum lipid control, and anthropometrics served as secondary outcomes.
RESULTS
Nine RCTs that randomized a total of 2609 adults revealed that MIR was statistically associated with better HbA1c lowering (MD 0.09% [0.01%, 0.17%]) and serum lipid control, and MXR only with reduced dyspepsia (RR 0.58 [0.34, 0.98]). MXR and MIR were similar in other considered outcomes.
CONCLUSIONS
MXR was associated with statistically worse but likely clinically insignificant HbA1c lowering, similar plasma glucose control, and minimal improvement of metformin intolerance versus MIR. Protocol Registration: PROSPERO (CRD42019148008).
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 2,609 participants or records.
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