Comparison between SGLT2 inhibitors and DPP4 inhibitors added to insulin therapy in type 2 diabetes: a systematic review with indirect comparison meta‐analysis

Abstract

Background Both sodium glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP4) inhibitors can be used to treat patients with type 2 diabetes mellitus (T2DM) that is inadequately controlled with insulin therapy, and yet there has been no direct comparison of these two inhibitors.

When metformin is not enough: Pros and cons of SGLT2 and DPP‐4 inhibitors as a second line therapy

“…This effect size was replicated when agents were compared to DPP‐4 inhibitors as add on therapy to metformin and in triple therapy . A systematic review also demonstrates that weight reduction was achieved when SGLT2 inhibitors (2 studies with dapagliflozin and empagliflozin and 2 study with canagliflozin) were added on to insulin therapy (weighted mean difference when compared to DPP‐4 inhibitors; −2.38 kg; 95% CI −3.18 to −1.58 kg) . The weight loss with dapagliflozin is also sustained at 4 years (weight change compared with glipizide at 208 weeks; −4.38 kg; 95% CI −5.31 to −3.46 kg) .…”

“…Indirect comparison meta‐analyses of efficacy in RCTs have also been performed. A comparison of 14 RCTs of SGLT2 inhibitors versus placebo (5 studies) and DPP‐4 inhibitors versus placebo (9 studies) as add on therapy to insulin demonstrated greater HbA1c reduction with SGLT2 inhibitors (relative HbA1c reduction; −0.24%; 95% CI −0.43 to −0.05%) . Neither class increased hypoglycaemia risk .…”

“…A comparison of 14 RCTs of SGLT2 inhibitors versus placebo (5 studies) and DPP‐4 inhibitors versus placebo (9 studies) as add on therapy to insulin demonstrated greater HbA1c reduction with SGLT2 inhibitors (relative HbA1c reduction; −0.24%; 95% CI −0.43 to −0.05%) . Neither class increased hypoglycaemia risk . An indirect comparison meta‐analysis of dapagliflozin as add on therapy to metformin demonstrated similar efficacy to DPP‐4 inhibitors .…”

Efficacy and safety of teneligliptin add-on to insulin monotherapy in Japanese patients with type 2 diabetes mellitus: a 16-week, randomized, double-blind, placebo-controlled trial with an open-label period

“…Esposito et al reported a tendency of a slight increase in body weight with the use of DPP-4 inhibitors [25], and the extent of the weight gain was similar to that observed in this study. Metaanalyses have reported that DPP-4 inhibitors, even when used as an add-on to insulin, are almost weight neutral [26][27][28]. In patients receiving insulin, weight gain was likely to occur [5].…”

Comparison of healthcare resource utilization and costs in patients with type 2 diabetes initiating dapagliflozin versus sitagliptin

“…In a meta‐analysis of second‐line treatments, DAPA provided similar HbA1c control with similar or lower risks of hypoglycaemia compared with DPP‐4 inhibitors, TZDs and SUs over 1 year, and provided the added benefit of weight loss . In a second meta‐analysis, SGLT2 inhibitors provided better glycaemic control and greater weight loss compared with DPP‐4 inhibitors without an increase in hypoglycaemia . This study was conducted to compare healthcare resource utilization and costs over 1 year among patients who initiated DAPA compared with patients who initiated SITA in a real‐world clinical setting.…”