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PLoS One. 2013 Oct 25;8(10):e76713. doi: 10.1371/journal.pone.0076713. eCollection 2013.

Impact of three oral antidiabetic drugs on markers of β-cell function in patients with type 2 diabetes: a meta-analysis.

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1
Department of Endocrinology, Changhai hospital, Second Military Medical University, Shanghai, China.

Abstract

BACKGROUND:

The effect of metformin, pioglitazone and sitagliptin on β-cell function in the treatment of type 2 diabetes is controversial. Therefore, we performed a systematic review and meta-analysis to obtain a better understanding in the β-cell effects of metformin, pioglitazone and sitagliptin.

METHODS:

We searched Pubmed and the Cochrane Center Register of Controlled Trials to identify relevant studies. Trials investigating effects of sitagliptin, metformin or pioglitazone on β-cell function were identified. The primary outcomes were homeostasis model assessment of β-cells (HOMA-β) and proinsulin/insulin ratio (PI/IR). Secondary outcome was hemoglobin A1c level. We used version 2 of the Comprehensive Meta Analysis software for all statistical analyses.

RESULTS:

Metformin monotherapy was more effective than sitagliptin in improving HOMA-β (18.01% (95% CI 11.09% to 24.94%) vs. 11.29% (95% CI 9.21% to 13.37%), P = 0.040) and more effective (-0.137 (95% CI -0.082 to -0.192)) than both sitagliptin (-0.064 (95% CI -0.036 to -0.092), P = 0.019) and pioglitazone (-0.068 (95% CI -0.044 to -0.093), P = 0.015) in decreasing PI/IR. Metformin and sitagliptin combined (40.23% (95%CI 32.30% to 48.16%)) were more effective than sitagliptin and pioglitazone (11.82% (95% CI 6.61% to 17.04%), P = 0.000) and pioglitazone and metformin(9.81% (95% CI 1.67% to 17.95%), P = 0.022) in improving HOMA-β and decreasing PI/IR (-0.177 (95% CI -0.118 to -0.237); -0.080 (95% CI -0.045 to -0.114), P = 0.007; -0.038 (95% CI, -0.005 to 0.071), P = 0.023).

LIMITATIONS:

The included RCTs were of short duration (12-54 weeks). We could not determine long term effects on β-cells.

CONCLUSIONS:

Metformin improves β-cell function more effectively than pioglitazone or sitagliptin in type 2 diabetes patients. Metformin and sitagliptin improved HOMA-β and PI/IR more than other combinations.

PMID:
24204660
PMCID:
PMC3808360
DOI:
10.1371/journal.pone.0076713
[Indexed for MEDLINE]
Free PMC Article
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