DPP-4 Inhibitors as Treatments for Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Wang, Qixian; Long, Min; Qu, Hua; Shen, Rufei; Zhang, Rui; Xu, Jing; Xiong, Xin; Wang, Hui; Wang, Cong-Yi

doi:10.1155/2018/5308582

Cited by 34 publications

(29 citation statements)

References 41 publications

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“…However, further investigation on downstream signaling was not performed. IL-6 is important for T cell proliferation and Th17 cells show an IL6-dependent increase (Wang et al, 2018;Winer et al, 2009). We have described that CD26 is correlated with augmented Th1 activation along with a marked increase of Th1 cytokines including IL-6.…”

Section: Cd4(+) and Cd8(+) T Cellsmentioning

confidence: 94%

“…Two studies showed significant HbA1c reduction of −0.27 and − 0.34% after DPP4is treatment for 8 or 4 weeks, respectively (Ellis et al, 2011;Farngren et al, 2012), while the other two studies didn't show any treatment-related differences (Garg et al, 2013;Hari Kumar et al, 2013). A metaanalysis from Wang et al revealed that the additional use of DPP4is results in a greater decrease in HbA1c levels compared to insulin monotherapy, although it is not significant (Wang, Long, et al, 2018).…”

Section: Dpp4/cd26 Inhibition On Autoimmune Diabetesmentioning

confidence: 99%

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Dipeptidyl peptidase 4 inhibitors and their potential immune modulatory functions

Shao

et al. 2020

Pharmacology & Therapeutics

162

129

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Section: Cd4(+) and Cd8(+) T Cellsmentioning

confidence: 94%

Section: Dpp4/cd26 Inhibition On Autoimmune Diabetesmentioning

confidence: 99%

Dipeptidyl peptidase 4 inhibitors and their potential immune modulatory functions

Shao

et al. 2020

Pharmacology & Therapeutics

162

129

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“…A meta-analysis looking at this topic was published early in 2018 [ 63 ]. Only five trials met the inclusion criteria, which included a total of 253 patients.…”

Section: Dpp-4 Inhibitorsmentioning

confidence: 99%

Metabolic Control in Type 1 Diabetes: Is Adjunctive Therapy the Way Forward?

et al. 2018

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Despite advances in insulin therapies, patients with type 1 diabetes (T1DM) have a shorter life span due to hyperglycaemia-induced vascular disease and hypoglycaemic complications secondary to insulin therapy. Restricting therapy for T1DM to insulin replacement is perhaps an over-simplistic approach, and we focus in this work on reviewing the role of adjuvant therapy in this population. Current data suggest that adding metformin to insulin therapy in T1DM temporarily lowers HbA1c and reduces weight and insulin requirements, but this treatment fails to show a longer-term glycaemic benefit. Agents in the sodium glucose co-transporter-2 inhibitor (SGLT-2) class demonstrate the greatest promise in correcting hyperglycaemia, but there are safety concerns in relation to the risk of diabetic ketoacidosis. Glucagon-like peptide-1 agonists (GLP-1) show a modest effect on glycaemia, if any, but significantly reduce weight, which may make them suitable for use in overweight T1DM patients. Treatment with pramlintide is not widely available worldwide, although there is evidence to indicate that this agent reduces both HbA1c and weight in T1DM. A criticism of adjuvant studies is the heavy reliance on HbA1c as the primary endpoint while generally ignoring other glycaemic parameters. Moreover, vascular risk markers and measures of insulin resistance—important considerations in individuals with a longer T1DM duration—are yet to be fully investigated following adjuvant therapies. Finally, studies to date have made the assumption that T1DM patients are a homogeneous group of individuals who respond similarly to adjuvant therapies, which is unlikely to be the case. Future longer-term adjuvant studies investigating different glycaemic parameters, surrogate vascular markers and harder clinical outcomes will refine our understanding of the roles of such therapies in various subgroups of T1DM patients.

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“…Newer classes of glucose‐lowering therapies for T2D have also been investigated for T1D. A meta‐analysis of five RCTs concluded that the addition of DPP‐4 inhibitors to insulin therapy showed no clear glycaemic benefit for patients with T1D vs insulin monotherapy . An RCT investigating the addition of the GLP‐1RA liraglutide or placebo to insulin therapy in patients with T1D observed greater reductions in A1C, blood glucose concentrations, blood pressure (BP), and body weight with liraglutide .…”

Section: Introductionmentioning

confidence: 99%

Sodium‐glucose co‐transporter inhibitors as adjunctive treatment to insulin in type 1 diabetes: A review of randomized controlled trials

Boeder

Edelman

2019

Diabetes Obesity Metabolism

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Many patients with type 1 diabetes (T1D) struggle to achieve glycaemic control and experience significant fluctuations in glucose concentrations, despite insulin treatment.Sodium-glucose co-transporter (SGLT)-2 inhibitors and dual SGLT-1/2 inhibitors increase glucose elimination via the kidneys and reduce hyperglycaemia via insulinindependent mechanisms. This review examines available efficacy and safety data for these agents under investigation as adjunctive therapy for T1D. Across randomized trials of up to 52 weeks, SGLT-2 inhibitors or SGLT-1/2 inhibitors as an adjunct to insulin demonstrated significant reductions in glycated haemoglobin, glucose exposure, and measures of glycaemic variability, as well as increased time in the target glycaemic range, compared with placebo. Non-glycaemic benefits included reductions in body weight and insulin doses, as well as improvements in some cardiovascular risk factors and treatment satisfaction. SGLT-2 inhibitors and SGLT-1/2 inhibitors were associated with similar rates of hypoglycaemia but a higher incidence of genitourinary infections, compared with placebo. Diabetic ketoacidosis occurred more often with SGLT-2 inhibitors and SGLT-1/2 inhibitors vs placebo, although the incidence was generally low.Risk mitigation strategies in light of clinical trial data are also discussed. Positive data from randomized controlled trials of the SGLT-2 inhibitor dapagliflozin have led to the approval of dapagliflozin as an adjunct to insulin in adults with T1D having body mass index ≥27 kg/m 2 in whom insulin does not provide adequate glycaemic control in Europe and to approval as an adjunct to insulin for adults with T1D in Japan. K E Y W O R D Scanagliflozin, dapagliflozin, empagliflozin, SGLT-2 inhibitor, type 1 diabetes

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DPP-4 Inhibitors as Treatments for Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Cited by 34 publications

References 41 publications

Dipeptidyl peptidase 4 inhibitors and their potential immune modulatory functions

Dipeptidyl peptidase 4 inhibitors and their potential immune modulatory functions

Metabolic Control in Type 1 Diabetes: Is Adjunctive Therapy the Way Forward?

Sodium‐glucose co‐transporter inhibitors as adjunctive treatment to insulin in type 1 diabetes: A review of randomized controlled trials

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