Open AccessEffects of dipeptidyl peptidase‐4 inhibitors in type 2 diabetes patients with moderate to severe chronic kidney disease: M eta‐analysis of randomized controlled trials using unadjusted data
Author(s) -
Yang Man,
Wang Ling,
Gu Lijie,
Yuan Weijie
Publication year - 2017
Publication title -
journal of diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.949
H-Index - 43
eISSN - 1753-0407
pISSN - 1753-0393
DOI - 10.1111/1753-0407.12546
Subject(s) - medicine , dipeptidyl peptidase 4 , placebo , kidney disease , confidence interval , randomized controlled trial , type 2 diabetes , diabetes mellitus , meta analysis , gastroenterology , sitagliptin , endocrinology , pathology , alternative medicine
Background Three meta‐analyses recently evaluated the effects of dipeptidyl peptidase ( DPP )‐4 inhibitors in type 2 diabetes ( T2D ) patients with chronic kidney disease ( CKD ). However, the combination of adjusted and unadjusted data in these meta‐analyses may be questionable. The present study performed a meta‐analysis of the effects of DPP ‐4 inhibitors in T2D patients with moderate to severe CKD using unadjusted data from randomized controlled trials ( RCT s). Methods The P ub M ed, E mbase (via O vid), and C ochrane C entral databases were searched for papers regarding the effects of DPP ‐4 inhibitors in CKD patients published before 1 A ugust 2016. Data were independently extracted by two authors. A pooled analysis of unadjusted data was performed using random‐effects models. Results Twelve studies representing 10 RCT s were included in the present analysis. Comparing mean HbA1c change between placebo and treatment, DPP ‐4 inhibitors significantly improved HbA1c levels at 12 weeks (mean difference [ MD ] –0.42; 95% confidence interval [ CI ] –0.54, −0.29), but improvements in HbA1c were seen only in dialysis patients at 24 weeks ( MD –0.52; 95% CI –0.72, –0.32)*. Improvements in HbA1c were equivalent between DPP ‐4 inhibitors and sulfonylureas at 52 or 54 weeks. There were no significant differences in the incidence of severe or any hypoglycemic events between DPP ‐4 inhibitors and control (placebo or sulfonylureas) at 12, 24, and 52 or 54 weeks. However, DPP ‐4 inhibitors induced fewer symptomatic hypoglycemic events compared with sulfonylureas at 52 or 54 weeks. *[Correction added on 30 October 2017, after first online publication: The value ‘0.32’ has been corrected to ‘−0.32’.] Conclusions The present analysis shows that DPP ‐4 inhibitors are effective and comparable with sulfonylureas in T2D patients with moderate to severe CKD .