Patient profiles of the initial cohort | Value | Source | |||||||||
Patient characteristics | Mean | SE | |||||||||
Age, year | 55.7 | 0.17 | |||||||||
Female proportion, % | 45.8 | 0.70 | |||||||||
Duration of diabetes, year | 0.50 | – | |||||||||
Height, metera | 1.65 | 0.02 | |||||||||
Smokers proportion, % | 22 | 0.50 | |||||||||
Modifiable risk factors | Mean | SE | |||||||||
HbA1c, % | 8.40 | 0.03 | |||||||||
TC, mg/dlb | 193.05 | 0.66 | |||||||||
HDL-C, mg/dlb | 46.33 | 0.20 | |||||||||
LDL-C, mg/dlb | 111.97 | 0.51 | |||||||||
SBP, mmHg | 129 | 0.18 | |||||||||
Weight, kgc | 68.20 | 2.42 | |||||||||
Treatment effects of first therapyd | Metformin | Source | |||||||||
Mean | SE | ||||||||||
HbA1c change, % | − 1.57 | 0.22 | Meta-analysis and indirect treatment comparison | ||||||||
TC change, mg/dlb | − 30.50 | 6.30 | |||||||||
HDL-C change, mg/dlb | 10.04 | 2.36 | |||||||||
SBP change, mmHg | − 0.36 | 2.26 | |||||||||
Weight change, kge | − 7.51 | 1.09 | |||||||||
Symptomatic hypoglycemia, %f | 1.81 | 1.04 | |||||||||
Severe hypoglycemia, %f | 0.04 | 0.02 | |||||||||
Gastrointestinal reactions, % | 2.15 | 1.06 | |||||||||
Treatment effects of second therapyd | Metformin + sulfonylurea | Metformin + thiazolidinedione | Metformin + α-glucosidase inhibitor | Metformin + glinide | Metformin + DPP-4 inhibitor | Source | |||||
Mean | SE | Mean | SE | Mean | SE | Mean | SE | Mean | SE | ||
HbA1c change, % | − 2.61 | 0.18 | − 2.40 | 0.22 | − 2.41 | 0.28 | − 2.64 | 0.25 | − 2.52 | 0.22 | Meta-analysis and indirect treatment comparison |
TC change, mg/dlb | − 6.56 | 2.36 | − 8.88 | 4.81 | − 31.66 | 12.06 | − 2.70 | 5.10 | − 24.32 | 5.46 | |
HDL-C change, mg/dlb | − 1.16 | 3.25 | 5.41 | 5.73 | 11.58 | 5.52 | − 4.63 | 6.50 | 2.70 | 4.24 | |
SBP change, mmHg | − 3.80 | 1.17 | − 4.64 | 3.06 | − 3.68 | 3.02 | – | – | − 6.22 | 2.52 | |
Weight change, kge | − 0.95 | 1.21 | − 1.42 | 1.69 | − 2.70 | 1.60 | − 8.06 | 1.43 | − 4.14 | 1.36 | |
Symptomatic hypoglycemia, %f | 4.46 | 0.57 | 1.52 | 0.98 | 0 | 1.37 | 0 | 1.19 | 0.54 | 1.06 | |
Severe hypoglycemia, %f | 0.09 | 0.01 | 0.03 | 0.02 | 0 | 0.03 | 0 | 0.02 | 0.01 | 0.02 | |
Gastrointestinal reactions, % | 4.62 | 0.59 | 7.62 | 1.41 | 9.62 | 1.55 | 7.62 | 1.74 | 6.62 | 1.27 | |
Treatment effects of third therapyd | Metformin + insulin | Metformin + GLP-1 receptor agonist | Source | ||||||||
Mean | SE | Mean | SE | ||||||||
HbA1c change, % | − 2.51 | 0.29 | − 2.89 | 0.20 | Meta-analysis and indirect treatment comparison | ||||||
TC change, mg/dlb | − 69.50 | 12.15 | − 55.60 | 7.88 | |||||||
HDL-C change, mg/dlb | – | – | 0 | 5.71 | |||||||
SBP change, mmHg | – | – | − 7.38 | 1.62 | |||||||
Weight change, kge | − 4.22 | 2.69 | − 7.54 | 0.92 | |||||||
Symptomatic hypoglycemia, %f | 3.47 | 0.58 | 3.47 | 0.58 | |||||||
Severe hypoglycemia, %f | 0.07 | 0.01 | 0.07 | 0.01 | |||||||
Gastrointestinal reactions, % | 11.78 | 2.22 | 6.78 | 0.98 | |||||||
Costs of glucose-lowering treatments | Cost, ¥ ($)g,i | Individual drug | Cost, ¥ ($)g,h | Source | |||||||
Metformin | 679.05 (98.30) | Metformin | 679.05 (98.30) | [23] | |||||||
Sulfonylurea | 632.74 (91.60) | Glyburide | 2.70 (0.39) | ||||||||
Glimepiride | 1210.95 (175.30) | ||||||||||
Gliclazide | 414.59 (60.02) | ||||||||||
Glipizide | 902.72 (130.68) | ||||||||||
Thiazolidinedione | 1148.06 (166.19) | Rosiglitazone | 938.83 (135.90) | ||||||||
Pioglitazone | 1357.28 (196.48) | ||||||||||
α-Glucosidase inhibitor | 1815.60 (262.83) | Acarbose | 1830.98 (265.05) | ||||||||
Voglibose | 1356.07 (196.30) | ||||||||||
Miglitol | 2259.77 (327.12) | ||||||||||
Glinide | 1124.13 (162.73) | Repaglinide | 1259.80 (182.37) | ||||||||
Nateglinide | 988.46 (143.09) | ||||||||||
DPP-4 inhibitor | 3069.95 (444.41) | Sitagliptin | 2814.34 (407.40) | ||||||||
Saxagliptin | 3017.02 (436.74) | ||||||||||
Vildagliptin | 3192.47 (462.14) | ||||||||||
Linagliptin | 3137.21 (454.14) | ||||||||||
Alogliptin | 3188.72 (461.60) | ||||||||||
GLP-1 receptor agonist | 14,578.94 (2110.44) | Exenatide | 18,990.33 (2749.03) | ||||||||
Liraglutide | 10,167.55 (1471.85) | ||||||||||
Insulin cost per kg weight per day | 0.137 (0.020) | – | – | ||||||||
Costs and utility changes associated with diabetes-related events | Fatal costs, ¥ ($)g | Non-fatal costs, ¥ ($)g | Maintenance costs, ¥ ($)g | Source | Utility change | Source | |||||
Mean | SE | Mean | SE | Mean | SE | Mean | SE | ||||
Ischemic heart disease | 21,574.18 (3123.07) | 6359.88 (920.65) | 23,860.32 (3454.01) | 1576.61 (228.23) | 3293.02 (476.70) | 435.07 (62.98) | Claims data | − 0.028 | 0.005 | [24] | |
Myocardial infarction | 39,463.58 (5712.74) | 8360.32 (1210.24) | 53,131.50 (7691.30) | 3774.74 (546.43) | 6543.01 (947.16) | – | − 0.028 | 0.005 | |||
Congestive heart failure | 35,521.34 (5142.06) | 13,196.13 (1910.27) | 32,469.77 (4700.31) | 6315.33 (914.21) | 3113.24 (450.67) | 1797.6 (260.22) | − 0.028 | 0.005 | |||
Stroke | 69,427.06 (10,050.24) | 18,792.10 (2720.34) | 25,465.96 (3686.44) | 2418.01 (350.03) | 4274.23 (618.74) | 735.06 (106.41) | − 0.101 | 0.006 | |||
Amputation | – | – | 22,281.86 (3225.52) | – | 3542.36 (512.79) | – | − 0.118 | 0.009 | |||
Blindness | – | – | 15,846.21 (2293.89) | 617.89 (89.45) | 5227.01 (756.66) | 484.87 (70.19) | − 0.022 | 0.005 | |||
End-stage renal disease | 15,531.40 (2248.32) | 3715.52 (537.86) | 16,002.73 (2316.55) | 554.07 (80.21) | 5595.21 (809.96) | 543.32 (78.65) | − 0.058 | 0.006 | |||
Symptomatic hypoglycemia | – | 0 | – | Assumed | − 0.007 | 0.002 | |||||
Severe hypoglycemia | – | 4116.10 (595.85) | – | [25] | − 0.008 | 0.004 | |||||
Gastrointestinal reactions | – | 0 | – | Assumed | − 0.034 | 0 | [26] | ||||
BMI per unit increase | – | – | – | − 0.0061 | 0.001 | [27] | |||||
BMI per unit decrease | – | – | – | + 0.0061 | 0.001 | ||||||
BMI-related costs | Costs, ¥ ($)g | BMI | Costs, ¥ ($)g | BMI | Costs, ¥ ($)g | Source | |||||
≤ 23 | 0 | 29 | 14,230.2 (2059.96) | 35 | 29,252.9 (4234.64) | [28] | |||||
24 | 1711.3 (247.73) | 30 | 16,734.0 (2422.41) | 36 | 31,756.7 (4597.09) | ||||||
25 | 4215.1 (610.18) | 31 | 19,237.8 (2784.86) | 37 | 34,260.5 (4959.54) | ||||||
26 | 6718.9 (972.63) | 32 | 21,741.6 (3147.31) | 38 | 36,764.3 (5321.99) | ||||||
27 | 9222.7 (1335.08) | 33 | 24,245.4 (3509.76) | 39 | 39,268.0 (5684.42) | ||||||
28 | 11,726.4 (1697.51) | 34 | 26,749.1 (3872.19) | ≥ 40 | 41,771.8 (6046.87) |