Cargando…
Dipeptidyl peptidase-4 inhibitors as add-on therapy to insulin in patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials
PURPOSE: Addition of the dipeptidyl peptidase-4 (DPP4) inhibitors to insulin in patients with type 2 diabetes mellitus (T2DM) may achieve better glycemic control. However, results of pilot randomized controlled trials (RCTs) are inconsistent. We aimed to perform a meta-analysis of RCTs to evaluate e...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710543/ https://www.ncbi.nlm.nih.gov/pubmed/31692532 http://dx.doi.org/10.2147/DMSO.S202024 |
_version_ | 1783446367604047872 |
---|---|
author | Wang, Na Yang, Tao Li, Jie Zhang, Xianfeng |
author_facet | Wang, Na Yang, Tao Li, Jie Zhang, Xianfeng |
author_sort | Wang, Na |
collection | PubMed |
description | PURPOSE: Addition of the dipeptidyl peptidase-4 (DPP4) inhibitors to insulin in patients with type 2 diabetes mellitus (T2DM) may achieve better glycemic control. However, results of pilot randomized controlled trials (RCTs) are inconsistent. We aimed to perform a meta-analysis of RCTs to evaluate efficacy and safety of DPP4 inhibitors compared with placebo/no treatment as add-on therapy to insulin in T2DM patients. MATERIALS AND METHODS: Relevant studies were identified via a search of PubMed, Cochrane Library, and Embase databases. A fixed or random effect model was applied according to the heterogeneity. RESULTS: Overall, 22 RCTs with 6,957 T2DM patients were included. Addition of DPP4 inhibitors to insulin was associated with significantly reduced HbA1c as compared with controls (weighed mean difference [WMD]: −0.54%, p<0.001). The benefits of DPP4 inhibitors as add-on therapy on HbA1c were independent of study design, follow-up duration, categories of DPP4 inhibitors used, and using of fixed/adjustable insulin doses as indicated by predefined subgroup analyses. Moreover, addition of DPP4 inhibitors to insulin was associated with significantly reduced fasting blood glucose (WMD: −0.47mmol/L, p<0.001), postprandial glucose at 2 hrs (WMD: −2.03 mmol/L, p<0.001), and daily dose of insulin (WMD: −2.73U/d, p<0.001), while body weight (WMD: 0.02 g, p=0.81) or risk of symptomatic hypoglycemia (risk ratio: 0.92, p=0.37) were not affected. CONCLUSIONS: Addition of DPP4 inhibitors to insulin significantly improved the glycemic control in T2DM patients without further increasing the risk of weight gain and hypoglycemia. |
format | Online Article Text |
id | pubmed-6710543 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-67105432019-11-05 Dipeptidyl peptidase-4 inhibitors as add-on therapy to insulin in patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials Wang, Na Yang, Tao Li, Jie Zhang, Xianfeng Diabetes Metab Syndr Obes Original Research PURPOSE: Addition of the dipeptidyl peptidase-4 (DPP4) inhibitors to insulin in patients with type 2 diabetes mellitus (T2DM) may achieve better glycemic control. However, results of pilot randomized controlled trials (RCTs) are inconsistent. We aimed to perform a meta-analysis of RCTs to evaluate efficacy and safety of DPP4 inhibitors compared with placebo/no treatment as add-on therapy to insulin in T2DM patients. MATERIALS AND METHODS: Relevant studies were identified via a search of PubMed, Cochrane Library, and Embase databases. A fixed or random effect model was applied according to the heterogeneity. RESULTS: Overall, 22 RCTs with 6,957 T2DM patients were included. Addition of DPP4 inhibitors to insulin was associated with significantly reduced HbA1c as compared with controls (weighed mean difference [WMD]: −0.54%, p<0.001). The benefits of DPP4 inhibitors as add-on therapy on HbA1c were independent of study design, follow-up duration, categories of DPP4 inhibitors used, and using of fixed/adjustable insulin doses as indicated by predefined subgroup analyses. Moreover, addition of DPP4 inhibitors to insulin was associated with significantly reduced fasting blood glucose (WMD: −0.47mmol/L, p<0.001), postprandial glucose at 2 hrs (WMD: −2.03 mmol/L, p<0.001), and daily dose of insulin (WMD: −2.73U/d, p<0.001), while body weight (WMD: 0.02 g, p=0.81) or risk of symptomatic hypoglycemia (risk ratio: 0.92, p=0.37) were not affected. CONCLUSIONS: Addition of DPP4 inhibitors to insulin significantly improved the glycemic control in T2DM patients without further increasing the risk of weight gain and hypoglycemia. Dove 2019-08-22 /pmc/articles/PMC6710543/ /pubmed/31692532 http://dx.doi.org/10.2147/DMSO.S202024 Text en © 2019 Wang et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Wang, Na Yang, Tao Li, Jie Zhang, Xianfeng Dipeptidyl peptidase-4 inhibitors as add-on therapy to insulin in patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials |
title | Dipeptidyl peptidase-4 inhibitors as add-on therapy to insulin in patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials |
title_full | Dipeptidyl peptidase-4 inhibitors as add-on therapy to insulin in patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials |
title_fullStr | Dipeptidyl peptidase-4 inhibitors as add-on therapy to insulin in patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials |
title_full_unstemmed | Dipeptidyl peptidase-4 inhibitors as add-on therapy to insulin in patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials |
title_short | Dipeptidyl peptidase-4 inhibitors as add-on therapy to insulin in patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials |
title_sort | dipeptidyl peptidase-4 inhibitors as add-on therapy to insulin in patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710543/ https://www.ncbi.nlm.nih.gov/pubmed/31692532 http://dx.doi.org/10.2147/DMSO.S202024 |
work_keys_str_mv | AT wangna dipeptidylpeptidase4inhibitorsasaddontherapytoinsulininpatientswithtype2diabetesmellitusametaanalysisofrandomizedcontrolledtrials AT yangtao dipeptidylpeptidase4inhibitorsasaddontherapytoinsulininpatientswithtype2diabetesmellitusametaanalysisofrandomizedcontrolledtrials AT lijie dipeptidylpeptidase4inhibitorsasaddontherapytoinsulininpatientswithtype2diabetesmellitusametaanalysisofrandomizedcontrolledtrials AT zhangxianfeng dipeptidylpeptidase4inhibitorsasaddontherapytoinsulininpatientswithtype2diabetesmellitusametaanalysisofrandomizedcontrolledtrials |