Safety and efficacy of dipeptidyl peptidase-4 inhibitors vs sulfonylurea in metformin-based combination therapy for type 2 diabetes mellitus: Systematic review and meta-analysis

Foroutan, Naghmeh; Muratov, Sergei; Levine, Mitchell

doi:10.25011/cim.v39i2.26481

Cited by 39 publications

(41 citation statements)

References 5 publications

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“…TZDs, insulin and sulfonylureas are associated with the most weight gain (1.5 to 5.0 kg) when added to metformin, whereas GLP-1 receptor agonists and SGLT2 inhibitors are associated with weight loss. Hypoglycemia risk is also lower with TZDs, DPP-4 inhibitors, SGLT2 inhibitors and GLP-1 receptor agonists compared to sulfonylureas and insulin (19,24,(62)(63)(64)(65)67,68). Network meta-analyses that indirectly compared the net benefits of second-and third-line treatment options have found similar results (21,23,24,(69)(70)(71).…”

Section: Effects Of Antihyperglycemic Agents On Glycemic Control and mentioning

confidence: 93%

“…Recent meta-analyses have summarized head-to-head comparisons of metformin-based combinations (19,24,62,63). Combinations of metformin with a sulfonylurea, a thiazolidinedione (TZD), an SGLT2 inhibitor and a DPP-4 inhibitor have comparable A1Clowering effects (19,24,(62)(63)(64)(65)(66), while the combination of metformin with a GLP-1 receptor agonist reduced A1C more than combination with a DPP-4 inhibitor. TZDs, insulin and sulfonylureas are associated with the most weight gain (1.5 to 5.0 kg) when added to metformin, whereas GLP-1 receptor agonists and SGLT2 inhibitors are associated with weight loss.…”

Section: Effects Of Antihyperglycemic Agents On Glycemic Control and mentioning

confidence: 99%

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Pharmacologic Glycemic Management of Type 2 Diabetes in Adults

Lipscombe¹,

Booth²,

Butalia³

et al. 2018

Canadian Journal of Diabetes

172

186

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Healthy behaviour interventions should be initiated in people newly diagnosed with type 2 diabetes.• In people with type 2 diabetes with A1C <1.5% above the person's individualized target, antihyperglycemic pharmacotherapy should be added if glycemic targets are not achieved within 3 months of initiating healthy behaviour interventions.• In people with type 2 diabetes with A1C ≥1.5% above target, antihyperglycemic agents should be initiated concomitantly with healthy behaviour interventions, and consideration could be given to initiating combination therapy with 2 agents.• Insulin should be initiated immediately in individuals with metabolic decompensation and/or symptomatic hyperglycemia.• In the absence of metabolic decompensation, metformin should be the initial agent of choice in people with newly diagnosed type 2 diabetes, unless contraindicated.• Dose adjustments and/or additional agents should be instituted to achieve target A1C within 3 to 6 months. Choice of second-line antihyperglycemic agents should be made based on individual patient characteristics, patient preferences, any contraindications to the drug, glucose-lowering efficacy, risk of hypoglycemia, affordability/access, effect on body weight and other factors.• In people with clinical cardiovascular (CV) disease in whom A1C targets are not achieved with existing pharmacotherapy, an antihyperglycemic agent with demonstrated CV outcome benefit should be added to antihyperglycemic therapy to reduce CV risk.• In people without clinical CV disease in whom A1C target is not achieved with current therapy, if affordability and access are not barriers, people with type 2 diabetes and their providers who are concerned about hypoglycemia and weight gain may prefer an incretin agent (DPP-4 inhibitor or GLP-1 receptor agonist) and/or an SGLT2 inhibitor to other agents as they improve glycemic control with a low risk of hypoglycemia and weight gain.• In people receiving an antihyperglycemic regimen containing insulin, in whom glycemic targets are not achieved, the addition of a GLP-1 receptor agonist, DPP-4 inhibitor or SGLT2 inhibitor may be considered before adding or intensifying prandial insulin therapy to improve glycemic control with less weight gain and comparable or lower hypoglycemia risk.

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Section: Effects Of Antihyperglycemic Agents On Glycemic Control and mentioning

confidence: 93%

Section: Effects Of Antihyperglycemic Agents On Glycemic Control and mentioning

confidence: 99%

Pharmacologic Glycemic Management of Type 2 Diabetes in Adults

Lipscombe¹,

Booth²,

Butalia³

et al. 2018

Canadian Journal of Diabetes

172

186

View full text Add to dashboard Cite

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“…Certainly, relative to sulfonylurea (SU) or insulin, the lower risk of hypoglycaemia with AHA is clear and widely accepted . However, relative to placebo, efficacy‐focused studies have been unable to delineate hypoglycaemia risk with these newer AHA, mainly due to the use of background SU and insulin.…”

Section: Introductionmentioning

confidence: 99%

Risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: A systematic review and meta‐analysis

Kamalinia

Josse

Donio

et al. 2019

Endocrino Diabet & Metabol

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Objectives: For patients with type 2 diabetes, newer antihyperglycaemic agents (AHA), including the dipeptidyl peptidase IV inhibitors (DPP4i), glucagon-like peptide-1 receptor agonists (GLP1RA) and sodium glucose co-transporter 2 inhibitors (SGLT2i) offer a lower risk of hypoglycaemia relative to sulfonylurea or insulin.However, it is not clear how AHA compare to placebo on risk of any hypoglycaemia.This study evaluates the risk of any and severe hypoglycaemia with AHA and metformin relative to placebo. Design: A systematic review and meta-analysis was conducted of randomized, placebo-controlled trials ≥12 weeks in duration. MEDLINE, Embase and the Cochrane Library were searched up to April 16, 2019. Studies allowing use of other diabetes medications were excluded. Mantel-Haenszel risk ratio with 95% confidence intervals were used to pool estimates based on class of AHA and number of concomitant therapies used.Patients: Eligible studies enrolled patients with type 2 diabetes ≥18 years of age.Results: 144 studies met our inclusion criteria. Any hypoglycaemia was not increased with AHA when used as monotherapy (DPP4i (RR 1.12; 95% CI 0.81-1.56), GLP1RA (1.77; 0.91-3.46), SGLT2i (1.34; 0.83-2.15)), or as add-on to metformin (DPP4i (0.95; 0.67-1.35), GLP1RA (1.24; 0.80-1.91), SGLT2i (1.29; 0.91-1.83)) or as triple therapy (1.13; 0.67-1.91). However, metformin monotherapy (1.73; 1.02-2.94) and dual therapy initiation (3.56; 1.79-7.10) was associated with an increased risk of any hypoglycaemia. Severe hypoglycaemia was rare not increased for any comparisons. Conclusions:Metformin and the simultaneous initiation of dual therapy, but not AHA used alone or as single add-on combination therapy, was associated with an increased risk of any hypoglycaemia relative to placebo. K E Y W O R D S diabetes mellitus, type 2, dipeptidyl peptidase IV inhibitor, glucagon-like peptide-1 receptor agonist, hypoglycaemia, sodium glucose co-transporter 2 inhibitor S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Kamalinia S, Josse RG, Donio PJ, Leduc L, Shah BR, Tobe SW. Risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: A systematic review and meta-analysis. Endocrinol Diab Metab. 2020;3:e00100. https ://doi.

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“…6 Comparable efficacy between gliptins and sulfonylurea when either is added to metformin has been proved in different meta-analyses. 7,8 DPP-4 inhibitors inhibit degradation of native GLP-1 and thus enhance the incretin effect. 9 Other desirable actions of GLP-1 are to delay gastric emptying, thereby dampening post prandial hyherglycemic excursions, and to promote satiety and inhibit energy intake, perhaps preventing weight gain and encouraging weight loss.…”

Section: Introductionmentioning

confidence: 99%

Role of teneligliptin in rural India as add-on third drug in patients with type 2 diabetes mellitus

et al. 2017

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Background: Teneligliptin was introduced in India in May 2015. It has gained popularity and is already widely prescribed in type 2 diabetes mellitus (T2DM). The main aim of our study was to assess the efficacy and superiority of teneligliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor as add-on third drug along with metformin and glimepiride in the treatment of type 2 diabetes mellitus in rural India.Methods: In this comparative observational study, three groups of uncontrolled type 2 diabetes (on monotherapy) patients each comprising 50 in number were studied for 3 months. Groups were divided into patients on triple drug regimens (Group A- Metformin+Glimepiride+voglibose; Group B- Metformin+Glimepiride+Pioglitazone and Group C- Metformin+Glimepiride+Teneligliptin). In each group FBS and PPBS were tested at the beginning and at 4 weeks intervals. HbA1c was tested at the start of study and at the end of 12 weeks.Results: After 12 weeks of therapy, it was observed that FBS, PPBS and HbA1c were significantly reduced in Group-C patients containing teneligliptin in comparison to Group-A and B containing voglibose and pioglitazone respectively.Conclusions: Teneligliptin significantly improves glycemic control in Indian patients with T2DM when prescribed as an add-on to one or more other commonly prescribed antidiabetic drugs, even in patients of rural India. It may be an ideal add-on third drug in the treatment of T2 DM patients.

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Safety and efficacy of dipeptidyl peptidase-4 inhibitors vs sulfonylurea in metformin-based combination therapy for type 2 diabetes mellitus: Systematic review and meta-analysis

Cited by 39 publications

References 5 publications

Pharmacologic Glycemic Management of Type 2 Diabetes in Adults

Pharmacologic Glycemic Management of Type 2 Diabetes in Adults

Risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: A systematic review and meta‐analysis

Role of teneligliptin in rural India as add-on third drug in patients with type 2 diabetes mellitus

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