DPP4 Inhibitors Provide Greater Long-Term Glycemic Control Than Sulfonylureas

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DPP4 inhibitors may be beneficial to add as a secondary medication to metformin.
DPP4 inhibitors may be beneficial to add as a secondary medication to metformin.

Dipeptidyl-peptidase 4 (DPP4) inhibitors provide greater long-term glycemic control than sulfonylureas in patients with type 2 diabetes, according to a meta-analysis published in Diabetes, Obesity and Metabolism.

Investigators conducted a meta-analysis of randomized controlled trials to determine the long-term benefit of DPP4 inhibitors vs sulfonylureas in managing blood sugar of patients with type 2 diabetes. The researchers evaluated changes in glycosylated hemoglobin (HbA1c) from either 26 or 52 weeks to 104 weeks of therapy. 

The 8 randomized controlled trials included in this analysis studied various DPP4 inhibitors, including alogliptin, linagliptin, saxagliptin, sitagliptin, and vildagliptin. 

Compared with sulfonylureas, the use of DPP4 inhibitors was associated with smaller rises in HbA1c level during 24 to 28 weeks (mean difference [MD]: -0.16%; 95% CI, -0.21 to -0.11; P <.001) as well as at 52 to 104 weeks (MD: -0.06%; 95% CI, -0.10 to -0.02; P =.001) of treatment. 

Additionally, the investigators found similar results following a sensitivity analysis after omitting a study that included medication-naive people with diabetes (MD: -0.15%; 95% CI, -0.20 to -0.10; P <.001) and 52 weeks (MD: -0.06%; 95% CI, -0.10 to -0.02; P =.003).

According to the investigators, there was a small difference in treatment effect size. Therefore, the benefit found with DPP4 inhibitors requires further validation in future randomized trials. The investigators also believe that a follow-up period of at least 2 years, compared with the 104-week follow-up in this analysis, is required to determine more conclusively whether there is a long-term benefit to using DPP4 inhibitors in patients with diabetes.

The initial results of this study suggest that the advantages seen with DPP4 inhibitors may be associated with their “beneficial effects on the preservation of β-cell numbers and β-cell functions” when compared with sulfonylureas.

Reference

Chen K, Kang D, Yu M, et al. Direct head-to-head comparison of glycemic durability of dipeptidyl peptidase-4 inhibitors and sulphonylureas in patients with type 2 diabetes mellitus: a meta-analysis of long-term randomized controlled trials [published online November 2, 2017]. Diabetes Obes Metab. doi:10.1111/dom.13147

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