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Diabetes Metab Res Rev. 2014 Mar;30(3):241-56. doi: 10.1002/dmrr.2482.

Head-to-head comparison of dipeptidyl peptidase-IV inhibitors and sulfonylureas - a meta-analysis from randomized clinical trials.

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State Key Laboratory of Medical Genomics, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrinology and Metabolism, Endocrine and Metabolic E-Institutes of Shanghai Universities (EISU)and Key Laboratory for Endocrinology and Metabolism of Chinese Health Ministry, Rui-jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.



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.


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 (HbA1c ), body weight, hypoglycaemia, total adverse events, and cardiovascular events were retrieved and analysed.


The analysis included 12 randomized studies comprising 10 982 patients with type 2 diabetes mellitus. On the basis of meta-analysis, sulfonylureas lowered HbA1c 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 HbA1c 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 HbA1c  < 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.


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.


body weight; dipeptidyl peptidase-IV; efficacy; hypoglycaemia; safety; sulfonylureas; type 2 diabetes

[Indexed for MEDLINE]

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