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Comparisons of the efficacy of glucose control, lipid profile, and β-cell function between DPP-4 inhibitors and AGI treatment in type 2 diabetes patients: a meta-analysis

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Abstract

The aim of this study is to compare the efficacy of dipeptidyl peptidase-4 (DPP-4) inhibitor treatment with α-glucosidase inhibitor (AGI) treatment in patients with type 2 diabetes through a meta-analysis. Studies were identified by a literature search of Medline, Embase, and others from the time that recording commenced until December 2014. The meta-analysis was performed by computing the weighted mean difference (WMD) and 95 % confidence interval (CI) for a change from baseline to the study endpoint for DPP-4 inhibitors versus AGIs. Nine randomized controlled trial were judged to be appropriate for inclusion in the meta-analysis. One thousand and forty-six patients were treated with a DPP-4 inhibitor, while 929 patients were treated with AGI treatment; the groups had a comparable baseline body mass index of 25.5 ± 1.3 kg/m2 and mean baseline HbA1c of 7.83 ± 0.53 %. Treatment with DPP-4 inhibitors led to a significantly greater change from baseline in the HbA1c levels (WMD −0.30 %; 95 % CI −0.47 to −0.13 %, p < 0.001) and fasting plasma glucose levels (WMD −0.50 mmol/L; 95 % CI −0.89 to −0.11 mmol/L, p = 0.01) compared with AGI treatment. Compared with AGIs, treatment with DPP-4 inhibitors was associated with a significantly greater increase in the weight change from baseline (WMD 0.89 kg; 95 % CI 0.53–1.25, p < 0.001). Treatment with DPP-4 inhibitors was associated with a significantly greater increase in the fasting insulin level from baseline (WMD 0.63 µU/mL; 95 % CI 0.35–0.90 µU/mL, p < 0.001). DPP-4 inhibitors significantly improved homeostatic model assessment for β-cell function in type 2 diabetes patients compared with AGI treatment (WMD 5.43; 95 % CI 1.01–9.85, p = 0.02). DPP-4 inhibitors were associated with a significantly greater decrease in the cholesterol (CHO) level (WMD −0.19 mmol/L; 95 % CI −0.19 to −0.19 mmol/L, p < 0.001) and a significantly greater decrease in the low-density lipoprotein cholesterol (LDL-C) level (WMD −0.16 mmol/L; 95 % CI −0.26 to −0.05 mmol/L, p = 0.003). Compared with AGIs (813 participants), treatment with DPP-4 inhibitors (1031 participants) was associated with a significantly lower incidence of drug-related adverse event (OR 0.48; 95 % CI 0.36–0.64, p < 0.0001). The efficacy of glucose control and improvement of β-cell function, as well as total CHO and LDL-C decreases, in DPP-4 inhibitor treatment were superior to those with AGI treatment, and there was a lower incidence of drug-related AE.

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Acknowledgments

This meta-analysis was supported by the National High-technology Research and Development Program of China (863 Program 2012AA02A509) and National Natural Science Foundation of China (NSFC) (81000334). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. We are grateful to all doctors and staff members for their practical work during the study at Peking University People’s Hospital Endocrinology and Metabolism Department.

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  1. Endocrine and Metabolism Department, Peking University People’s Hospital, Beijing, 100044, China

    Xiaoling Cai, Wenjia Yang, Lingli Zhou, Simin Zhang, Xueyao Han & Linong Ji

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Correspondence to Linong Ji.

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Cai, X., Yang, W., Zhou, L. et al. Comparisons of the efficacy of glucose control, lipid profile, and β-cell function between DPP-4 inhibitors and AGI treatment in type 2 diabetes patients: a meta-analysis. Endocrine 50, 590–597 (2015). https://doi.org/10.1007/s12020-015-0653-3

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