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Type 2 diabetes is a serious, chronic disease that can increase the risk of death, heart attack, stroke and kidney disease. This overview of reviews updates evidence comparing the effects of the currently recommended treatment (sulfonylurea + metformin) to treatment with newer anti-diabetic mediations (DPP-4 inhibitors or GLP-1 analogs) added to metformin when neither life-style changes nor metformin alone are effective in reducing blood sugar levels. 1. No conclusions can be drawn about the effect on mortality of adding DPP-4 inhibitor versus sulfonylurea to metformin because of few events and low quality evidence. There was no documentation for the effect on mortality of adding GLP-1 analogs versus sulfonylurea to metformin.2. We found no evidence on the effects on micro and macrovascular complications for either comparison.3. Results for intermediate outcomes (HbA1c change, weight, hypoglycemic incidents) are mixed. Reduction in HbA1c is larger with sulfonylurea, but DPP-4 inhibitors and GLP-1 analogs result in more weight loss and a lower risk of a hypoglycemic episode.4. All differences are small in magnitude and may be clinically unimportant.5. Sulfonylurea + metformin is substantially less costly than either DPP-4 inhibitors or GLP-1 analogs + metformin.

Hypoglycemic agents.

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The global burden of diabetes is increasing worldwide. Diabetes and its complications contribute to significant morbidity and economic burden on national health. Despite the growing number of antidiabetic drugs available, their utilization pattern in Belgium is not well studied. The purpose of this study was to analyze the overall trends in the utilization of antidiabetics among aider (aged; 65 years) Belgians between 2005 and 2015, and to stratify the utilization by age, sex and regions. Methods: A repeated cross-sectional analysis of the national utilization of all reimbursed diabetic medications in Belgium were included in the analysis. lndividual level dispensing data for the period between 2005 and 2015 was extracted from Pharmanet dataset, supplied by the Belgian National lnstitute for Health and Disability Insurance (INAMl-RIZIV). Utilization data was categorized in accordance with the World Health Organization Collaborating Centre for Drug Statistics Methodology's Anatomical Therapeutic Chemical classification system. The use of antidiabetics was expressed in defined daily doses (DDD) per thousand aider people per day (TOPO).Results: The utilization of antidiabetic drugs in Belgium increased by 35.3% between 2005 and 2015. The highest utilization was found in the 70-74 age bands. At the regional level, there was a net difference between the Walloon region, the Flemish region and Brussels. The distribution of their utilization was respectively 61.1% for Wallonia, 34.4% for the Flemish part and 4.5% for Brussels. ln Belgium, metformin remains the first-choice (34.5%) antidiabetic medicine for the management of diabetes. The newest antidiabetic medications such as DPP-4 inhibitors have distinguished itself by exceptional growth over a very short period (took the third place in the market in five years).Conclusion: There was a significant increase in the utilization of antidiabetic medicines between 2005 and 2015 in Belgium among the aider population. Newly approved antidiabetic medicines have contributed to significant growth, especially the DPP-4 inhibitors. Belgium is still waiting for a National Plan for diabetes, which would describe the main lines and strategic objectives in the coming years.

Pharmacoepidemiology --- Hypoglycemic Agents

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Hypoglycemic agents. --- Natural products.

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Hypoglycemic Agents --- Kinetics --- pharmacokinetics

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Diabetes Mellitus --- Pharmaceutical Preparations --- Metabolic Diseases --- Glucose Intolerance --- Pharmacology --- Pharmacology, Clinical --- Biological Science Disciplines --- Hypoglycemic agents --- Hypoglycemic Agents. --- Antidiabetic Agents --- Antidiabetic Drugs --- Antihyperglycemic Agents --- Antihyperglycemics --- Hypoglycemic Drugs --- Hypoglycemic Effect --- Hypoglycemic Effects --- Hypoglycemics --- Antidiabetics --- Agents, Antidiabetic --- Agents, Antihyperglycemic --- Agents, Hypoglycemic --- Drugs, Antidiabetic --- Drugs, Hypoglycemic --- Effect, Hypoglycemic --- Effects, Hypoglycemic --- Hypoglycemic agents. --- Hypoglycemic Agents --- Drugs --- Hypoglycemia --- Antidiabetic --- Antidiabetic Agent --- Antidiabetic Drug --- Antihyperglycemic --- Antihyperglycemic Agent --- Hypoglycemic --- Hypoglycemic Agent --- Hypoglycemic Drug --- Agent, Antidiabetic --- Agent, Antihyperglycemic --- Agent, Hypoglycemic --- Drug, Antidiabetic --- Drug, Hypoglycemic