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Head‐to‐head comparison of dipeptidyl peptidase‐IV inhibitors and sulfonylureas – a meta‐analysis from randomized clinical trials
Author(s) -
Zhang Yifei,
Hong Jie,
Chi Jie,
Gu Weiqiong,
Ning Guang,
Wang Weiqing
Publication year - 2014
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.2482
Subject(s) - medicine , odds ratio , randomized controlled trial , meta analysis , confidence interval , diabetes mellitus , adverse effect , type 2 diabetes , gastroenterology , endocrinology
Abstract Background Dipeptidyl peptidase‐IV (DPP‐4) inhibitors and sulfonylureas are two important second‐line anti‐diabetic agents. The objective of this research was to evaluate the efficacy and safety of DPP‐4 inhibitors compared with sulfonylureas by meta‐analytic approach of available randomized studies. Methods We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases up to 30 June 2013, collecting all randomized clinical trials with a treatment duration of ≥18weeks. Data on glycated haemoglobin (HbA 1c ), body weight, hypoglycaemia, total adverse events, and cardiovascular events were retrieved and analysed. Results The analysis included 12 randomized studies comprising 10 982 patients with type 2 diabetes mellitus. On the basis of meta‐analysis, sulfonylureas lowered HbA 1c significantly more than DPP‐4 inhibitors with weighted mean difference (WMD) of 0.105 [95% confidence interval (CI) 0.103 to 0.107]. The results were consistent in trials with longer (>32 weeks) or shorter (≤32 weeks) duration; however, DPP‐4 inhibitors showed greater reduction in HbA 1c compared with the second‐generation sulfonylureas and in patients with baseline eGFR < 50 mL/min/1.73 m 2 . Patients treated with DPP‐4 inhibitors are less likely to achieve HbA 1c < 7% compared with sulfonylureas [Mantel–Haenszel odds ratio (MH‐OR) 0.91; 95% CI 0.84 to 0.99]. DPP‐4 xinhibitors were associated with a reduction in body weight (WMD −1.652; 95% CI −1.658 to −1.646) and lower risk of hypoglycaemia (MH‐OR, 0.13; 95% CI 0.11 to 0.16), total adverse events (MH‐OR, 0.79; 95% CI 0.72 to 0.87), and cardiovascular events (MH‐OR, 0.53; 95% CI 0.32 to 0.87) compared with sulfonylureas. Conclusion Although DPP‐4 inhibitors are less efficacious compared with sulfonylureas, they demonstrate a beneficial effect on body weight, episodes of hypoglycaemia, and total adverse events. Copyright © 2013 John Wiley & Sons, Ltd.