Head-to-Head Comparison of the Hypoglycemic Efficacy and Safety Between Dipeptidyl Peptidase-4 Inhibitors and α-Glucosidase Inhibitors in Patients With Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background: The α-glucosidase inhibitors (AGIs) are commonly prescribed in Asian patients with type 2 diabetes mellitus (T2DM), but with a high incidence of gastrointestinal side effects. This study was aimed to compare the efficacy and safety of dipeptidyl peptidase-4 (DPP4) inhibitors and AGIs in T2DM patients in a meta-analysis. Methods: Randomized controlled trials were identified via systematic search of PubMed, Embase, and Cochrane’s Library databases from inception to February, 2019. Meta-analyses were performed via a random or a fixed effect model according to the heterogeneity. Results: Eighteen studies with a total of 4,051 patients with T2DM were included. The DPP4 inhibitors were associated with lower reduction of glycosylated hemoglobin (HbA1c) as compared with AGIs [weighed mean difference (WMD): −0.37%, p < 0.001]. Subgroup analyses indicated that the benefit of DPP4 inhibitors as compared with AGIs on HbA1c were independent of study design, scale, baseline HbA1c, with or without concurrent medications, or follow-up durations. Moreover, compared to AGIs, DPP4 inhibitors was associated with lower reductions of fasting blood glucose (WMD: −0.53 mmol/L, P < 0.001) and postprandial glucose at 2h (WMD: −0.60 mmol/L, P = 0.04), moderately increased body weight (WMD: 0.34 kg, P = 0.02), and decreased risk of gastrointestinal adverse events [risk ratio (RR): 0.48, P < 0.001], but unaffected risk of symptomatic hypoglycemia (RR: 0.96, P = 0.90). Conclusions: The DPP4 inhibitors are superior to AGIs in T2DM patients for better glycemic control and lower risks of gastrointestinal side effects.

Acarbose With Comparable Glucose-Lowering but Superior Weight-Loss Efficacy to Dipeptidyl Peptidase-4 Inhibitors: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

“…Plenty of evidence has demonstrated that acarbose and DPP-4is at least have a weight-neutral effect (1,2,19,37). In consistence with the previous meta-analyses, acarbose was associated with a significant weight reduction compared with DPP-4is in our NMA (3,5). In accordance with previous studies, alogliptin probably had a greater weight reduction effect than linagliptin, sitagliptin, and vildagliptin (35,36).…”

“…Our NMA revealed that compared with placebo, acarbose and DPP-4is had significant hypoglycemic effects, since they both have a comparable glucose-lowering efficacy with their optimal doses. This result is quite different from our own and previous meta-analyses, suggesting that DPP-4is are superior to AGIs at glucose reduction (3,5,7). The reasons for the inconsistency may be as follows: Firstly, due to the limited source of pair-wise trials, one study, respectively, compared AGIs or DPP-4is with placebo, so the results may mislead the readers (7).…”

“…The reasons for the inconsistency may be as follows: Firstly, due to the limited source of pair-wise trials, one study, respectively, compared AGIs or DPP-4is with placebo, so the results may mislead the readers (7). Secondly, the previous meta-analyses included only few acarbose studies, which were not sufficient to draw a representative conclusion (3,5). Thirdly, the dosages of acarbose varied quite differently in the existed trials, while a dose of 300 mg/day has been shown to be the most efficacious worldwide (23).…”

“…Acarbose and DPP-4is are two popular hypoglycemic agents, at least in East Asia. A growing evidence has focused on comparing between AGIs and DPP-4is (3)(4)(5)(6)(7)(8)(9). However, the pairwise studies are quite limited, and the previous meta-analyses did not concentrate on acarbose.…”

Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future

“…Newer oral medicines for patients with T2DM such as the DPP4 (dipeptidyl peptidase-4) and SGLT2 (sodium/glucose cotransporter 2) inhibitors have also been proposed (Naidoo et al, 2014;Imprialos et al, 2017;Bailey and Day, 2019;Li et al, 2019). However, there are major issues with affordability within public healthcare systems struggling to routinely make available metformin and basic insulins.…”