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Diabetes Res Clin Pract. 2016 Jun;116:86-95. doi: 10.1016/j.diabres.2016.03.011. Epub 2016 Apr 23.

Efficacy and safety of the addition of a dipeptidyl peptidase-4 inhibitor to insulin therapy in patients with type 2 diabetes: A systematic review and meta-analysis.

Author information

1
Division of Endocrinology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.
2
Division of Endocrinology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
3
Department of Medicine, Seoul National University College of Medicine/Biostatistics Division of Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea.
4
Division of Endocrinology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: ymchomd@snu.ac.kr.

Abstract

AIMS:

To compare the efficacy and safety of the addition of a dipeptidyl peptidase-4 (DPP-4) inhibitor or a placebo in patients with type 2 diabetes inadequately controlled with insulin.

METHODS:

We searched randomised controlled trials (RCTs) from MEDLINE, EMBASE, LILACS, the Cochrane Central Register of Controlled Trials and the ClinicalTrials.gov online registry. Studies of at least 12week treatment duration were eligible if they were RCTs in patients with type 2 diabetes comparing addition of a DPP-4 inhibitor to insulin therapy (INS/DPP4i) with addition of a placebo to insulin therapy (INS/PCB) and contained information on the change in glycated haemoglobin (HbA1c) from baseline.

RESULTS:

Of 3105 potentially relevant published articles and 206 registered trials, 9 studies were included for meta-analysis. Compared to INS/PCB, INS/DPP4i exhibited a greater reduction in HbA1c (weighted mean difference [WMD] -0.58%; 95% CI -0.70, -0.46) and fasting plasma glucose (WMD -0.59mmol/L; 95% CI -0.79, -0.40) with less daily insulin doses (WMD -1.86IU; 95% CI -3.27, -0.45) and with no difference in weight gain (WMD -0.04kg; 95% CI -0.25, 0.16). The risk of hypoglycaemia was similar between INS/DPP-4i and INS/PCB (the RR in favour of INS/PCB was 0.94; 95% CI 0.84, 1.05).

CONCLUSIONS:

Compared to placebo, DPP-4 inhibitors exhibit a better glycaemic control without further increasing the risk of weight gain and hypoglycaemia in patients with type 2 diabetes inadequately controlled with insulin.

KEYWORDS:

Dipeptidyl peptidase-4 inhibitor; Insulin; Meta-analysis; Systematic review; Type 2 diabetes

PMID:
27321321
DOI:
10.1016/j.diabres.2016.03.011
[Indexed for MEDLINE]

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