The Efficacy and Safety of Hypoglycemic Agents in the Middle-Aged and Elderly Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis

Abstract

Background: We aimed to evaluate the efficacy and safety of combined hypoglycemic agents and insulin therapy in the middle-aged and elderly patients with diabetes through a meta-analysis.

Methods: Literature was searched in PubMed, Cochrane Library, EMbase, Web of Science, WanFang, VIP, and CNKI databases for studies on the combined use of hypoglycemic agents and insulin therapy in the middle-aged and elderly patients with diabetes, with a search time limit up to February 2023.

Results: This article includes 8 RCTs. The risk of bias assessment shows that one article had a low risk of bias, one article have an unclear risk of bias, and 6 articles have a high risk of bias. The meta-analysis results show that the combination of hypoglycemic agents and insulin has better blood glucose control (P=0.0001); fasting blood glucose reduction is more significant (P<0.00001); the 2-hour postprandial blood glucose reduction is more noticeable (P=0.002); HbA1c reduction is more pronounced (P=0.005); however, there is no difference in the incidence of adverse reactions between the two groups (P=0.09).

Conclusion: The combination of hypoglycemic agents and insulin in the treatment of middle-aged and elderly diabetic patients can reduce the fasting blood glucose, the 2-hour postprandial blood glucose, and HbA1c, and reduce adverse reactions. However, due to the limitations in the number and quality of the included studies, the conclusion still requires further verification from more high-quality RCTs.