Type 2 diabetes

Overview

Recognition

Symptoms often develop slowly, and many people have none.

Assessment

A health care professional can diagnose type 2 diabetes with blood tests.

Burden

No burden claims are published.

Claims and evidence

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

• Claim, not a settled fact NIDDK and MedlinePlus name diabetes as a most common cause of chronic kidney disease in adults: Chronic kidney disease (CKD) (Associated with a higher risk of)

  Applies to Adult

  • Adults with chronic kidney disease, or at higher risk of it, for example because of diabetes or high blood pressure.
  • Not stated; patient information pages
  • Not stated; United States federal health agencies
  • Adults

  Follow-up Not applicable (descriptive page)
  The NIDDK chronic kidney disease page says that diabetes and high blood pressure are the most common causes of chronic kidney disease in adults. The MedlinePlus chronic kidney disease summary says the same.

  Limitations. Patient-information pages. Both pages say diabetes without separating type 1 from type 2, so this atlas does not claim the statement is specific to type 2 diabetes. The pages give no size of the risk.

• Claim, not a settled fact NIDDK says unmanaged diabetes can lead to heart disease and stroke: Stroke (Associated with a higher risk of)

  Applies to Mixed recipients

  • People with type 2 diabetes. The NIDDK page says type 2 diabetes can develop at any age, including childhood, and occurs most often in middle-aged and older people.
  • Not stated; patient information pages
  • Not stated; United States federal health agencies
  • All ages; most common in middle-aged and older people
  • Gestational age Not reported
  • Postnatal age Not reported

  Follow-up Not applicable (descriptive page)
  The NIDDK type 2 diabetes page says that, if not managed, diabetes can lead to problems such as heart disease and stroke, and also to nerve damage, kidney disease, foot problems and eye disease.

  Limitations. A patient-information page. It says diabetes can lead to these problems if it is not managed, and gives no size for the risk, no time frame and no comparison with people who do not have diabetes. This atlas treats it as a description, not as an estimate.

• Claim, not a settled fact Evaluated for this: HbA1c blood test (Evaluated for, seen from the other side)

  Applies to Mixed recipients

  • People who are screened for diabetes or prediabetes with an HbA1c test, and people with diabetes or prediabetes whose condition is monitored with it.
  • Not stated; patient information page
  • Not stated; United States federal health agency
  • All ages; the page gives screening advice by adult age and risk factors
  • Gestational age Not reported
  • Postnatal age Not reported

  Follow-up Not applicable (descriptive page)
  MedlinePlus says an HbA1c test is a blood test that shows the average level of blood glucose over the past two to three months. It may be used to screen for or diagnose type 2 diabetes and prediabetes, and to help monitor people who have diabetes or prediabetes. It is not used to diagnose type 1 diabetes but may be used to monitor blood glucose levels in type 1 diabetes.

  Limitations. A patient-information page from the National Library of Medicine. It gives no diagnostic cut-off values in the passages read, so this atlas gives none.

• Claim, not a settled fact Evaluated for this: Dapagliflozin (Evaluated for, seen from the other side)

  Applies to Adult

  • Patients with type 2 diabetes who had or were at risk for atherosclerotic cardiovascular disease; 10,186 of the 17,160 evaluated did not have atherosclerotic cardiovascular disease. The registry gives a minimum age of 40 years.
  • Multicenter trial. The care setting is not described further in the sources read.
  • Multinational. The registry lists the sites by country on the study page.
  • Adults aged 40 years or older (registry minimum age 40 years)

  Follow-up Median follow-up 4.2 years.
  In DECLARE-TIMI 58, patients with type 2 diabetes who had or were at risk for atherosclerotic cardiovascular disease took dapagliflozin or placebo. The paper evaluated 17,160 patients, 10,186 of them without atherosclerotic cardiovascular disease, for a median of 4.2 years. Dapagliflozin met the prespecified noninferiority criterion for the primary safety outcome of major adverse cardiovascular events (upper boundary of the 95% CI below 1.3). It did not lower the rate of major adverse cardiovascular events: 8.8% on dapagliflozin and 9.4% on placebo (hazard ratio 0.93; 95% CI 0.84 to 1.03; P=0.17). It did lower the rate of cardiovascular death or hospitalization for heart failure (4.9% against 5.8%; hazard ratio 0.83; 95% CI 0.73 to 0.95), which reflected fewer hospitalizations for heart failure (hazard ratio 0.73; 0.61 to 0.88); there was no difference in cardiovascular death (0.98; 0.82 to 1.17). A renal event occurred in 4.3% against 5.6% (hazard ratio 0.76; 0.67 to 0.87), and death from any cause in 6.2% against 6.6% (0.93; 0.82 to 1.04). Diabetic ketoacidosis was more common on dapagliflozin (0.3% against 0.1%; P=0.02), as were genital infections that led to stopping the medicine or were serious (0.9% against 0.1%; P<0.001).

  Limitations. The primary efficacy outcome for major adverse cardiovascular events was null, so the benefit shown is for the second primary efficacy outcome, driven by heart-failure hospitalization. The registry counts 17,190 enrolled and the abstract 17,160 evaluated; this atlas does not reconcile them. Funded by AstraZeneca (named in the abstract). Only the PubMed abstract was read. The claim is about dapagliflozin as tested in this one trial; it does not pool the other dapagliflozin trials, which sit in other claims.

• Claim, not a settled fact Evaluated for this: Empagliflozin (Evaluated for, seen from the other side)

  Applies to Adult

  • Patients with type 2 diabetes at high cardiovascular risk. The registry gives a minimum age of 18 years.
  • Multicenter, international trial (registry official title). The care setting is not described further in the sources read.
  • Multinational. The registry lists the sites by country on the study page.
  • Adults aged 18 years or older (registry minimum age 18 years)

  Follow-up Median observation time 3.1 years in 7020 treated patients.
  In EMPA-REG OUTCOME, patients with type 2 diabetes at high cardiovascular risk were randomly assigned to 10 mg or 25 mg of empagliflozin or placebo once a day, added to standard care; 7020 patients were treated, with a median observation time of 3.1 years. The primary outcome (death from cardiovascular causes, nonfatal heart attack or nonfatal stroke) occurred in 490 of 4687 patients (10.5%) in the pooled empagliflozin group and 282 of 2333 (12.1%) on placebo (hazard ratio 0.86; 95.02% CI 0.74 to 0.99; P=0.04 for superiority). Rates of heart attack and stroke did not differ significantly, but rates were lower on empagliflozin for death from cardiovascular causes (3.7% against 5.9%; a 38% relative reduction), hospitalization for heart failure (2.7% against 4.1%; 35%) and death from any cause (5.7% against 8.3%; 32%). There was no significant difference in the key secondary outcome (P=0.08). Genital infection was more frequent on empagliflozin.

  Limitations. The two empagliflozin doses were analysed together against placebo. The abstract gives the percentages for cardiovascular death, heart-failure hospitalization and all-cause death with relative reductions, not hazard ratios, and this record repeats them as printed. Funded by Boehringer Ingelheim and Eli Lilly (named in the abstract). Only the PubMed abstract was read. The claim is about empagliflozin as tested in this one trial; it does not pool the other empagliflozin trials, which sit in other claims.

• Claim, not a settled fact Evaluated for this: GLP-1 receptor agonists (drug class) (Evaluated for, seen from the other side)

  Applies to Adult

  • Adults aged 18 years or older with type 2 diabetes, in randomized trials that compared a GLP-1 receptor agonist with placebo and had a primary outcome that included cardiovascular death, nonfatal myocardial infarction and nonfatal stroke.
  • Not stated in the abstract
  • Not stated in the abstract
  • Adults aged 18 years or older

  Follow-up Not stated for the pooled analysis. The literature search ran up to 18 September 2017.
  A 2018 meta-analysis pooled four cardiovascular outcome trials of GLP-1 receptor agonists in adults with type 2 diabetes: ELIXA (lixisenatide), LEADER (liraglutide), SUSTAIN 6 (semaglutide) and EXSCEL (extended-release exenatide). Compared with placebo, the drugs lowered the risk of the three-point major adverse cardiovascular event outcome (cardiovascular death, nonfatal heart attack or nonfatal stroke) by 10 percent (hazard ratio 0.90, 95% CI 0.82 to 0.99; p=0.033). Cardiovascular death was 13 percent lower (0.87, 0.79 to 0.96) and death from any cause 12 percent lower (0.88, 0.81 to 0.95). The authors found no significant effect on fatal and non-fatal heart attack, fatal and non-fatal stroke, hospital admission for unstable angina, or hospital admission for heart failure. They also found no significant differences in severe hypoglycaemia, pancreatitis, pancreatic cancer or medullary thyroid cancer.

  Limitations. A pooled analysis of published trials of four different drugs, not of one drug. The abstract says the benefit varied to varying degrees between individual drugs and that between-trial heterogeneity was low to moderate. The search ran only up to 18 September 2017, so later trials, such as SELECT and SURPASS-CVOT in this atlas, are not in it. The abstract names the funding as Amylin Pharmaceuticals (AstraZeneca). The abstract does not grade certainty. Only the PubMed abstract was read.

• Claim, not a settled fact Evaluated for this: Tirzepatide (Evaluated for, seen from the other side)

  Applies to Adult

  • Patients with type 2 diabetes and atherosclerotic cardiovascular disease. The registry gives a minimum age of 40 years. The modified intention-to-treat population had a mean age of 64.1 years and 29.0 percent were women.
  • Multicenter trial. The care setting is not described further in the sources read.
  • Multinational. The registry lists the sites by country on the study page.
  • Patients aged 40 years or older (registry minimum age 40 years); mean age 64.1 years

  Follow-up Follow-up time is not given in the abstract.
  SURPASS-CVOT compared a weekly injection of tirzepatide (up to 15 mg) with weekly dulaglutide (1.5 mg), an agent shown to reduce cardiovascular events, in patients with type 2 diabetes and atherosclerotic cardiovascular disease. The analysis population was 6586 patients on tirzepatide and 6579 on dulaglutide. The first death from cardiovascular causes, heart attack or stroke occurred in 801 patients (12.2%) on tirzepatide and 862 (13.1%) on dulaglutide (hazard ratio 0.92; 95.3% CI 0.83 to 1.01; P=0.003 for noninferiority; P=0.09 for superiority). Tirzepatide was therefore noninferior to dulaglutide, but the trial did not show that it was superior. Adverse events appeared similar in the two groups, with more gastrointestinal adverse events on tirzepatide.

  Limitations. The comparison is with another GLP-1 medicine, not with placebo, so the result does not show how tirzepatide compares with no treatment. Noninferiority was tested with a margin of 1.05 for the upper limit of the 95.3% confidence interval; the abstract sets an upper limit below 1.00 as superiority, which was not reached. Funded by Eli Lilly (named in the abstract). Only the PubMed abstract was read.

Record details

Record id

cardio:type-2-diabetes

Content hash

fb232e459ed555887f32ebb7a23c0fc4c2815e04424cd810ee204212403358e9