The efficacy and safety of DPP4 inhibitors in patients with type 1 diabetes: A systematic review and meta-analysis. (November 2016) - Guo, Heming
Highlights: We evaluated the efficacy of DPP4 inhibitors in patients with type 1 diabetes. DPP4 inhibitors as add-on to insulin do not increase the risk of hypoglycemia. There is no beneficial effect of DPP4 inhibitors in decreasing HbA1c levels. Abstract: Aims: Dipeptidyl peptidase-4 (DPP4) inhibitors are a novel class of antidiabetic medication in the treatment of type 2 diabetes mellitus. Several studies have indicated that DPP4 inhibitors could be used for type 1diabetes (T1DM). Here, we performed a meta-analysis to assess the efficacy and safety of DPP4 inhibitor therapy in patients with T1DM. Methods: We conducted searches on Medline, Cochrane Library, Web of Science, and EMBASE for relevant studies published before November 21, 2015. Mean difference (MD) with 95% confidence interval (CI) was calculated for the mean glycated hemoglobin (HbA1c) changes and insulin dosage from baseline to endpoint. Risk ratio (RR) with 95% CI was calculated for severe hypoglycemia. Data was extracted by two independent reviewers, and the meta-analysis was performed using Review Manager version 5.3. Results: Six randomized controlled trials with a total of 228 individuals were finally included into the meta-analysis. DPP4 inhibitors reduced daily insulin dosage significantly (MD −2.41 U/day, 95% CI [−3.87, −0.94], P = 0.001) but did not reduce HbA1c level (MD 0.0% (0 mmol/mol), 95% CI [−0.16, 0.15], P = 0.97). Furthermore, DPP4 inhibitors did not change the incidence of severe hypoglycemia (RR 0.81, 95% CI [0.34, 1.93], P = 0.64). Conclusion: In patients with T1DM, DPP4 inhibitors combined with insulin do not increase or decrease the risk of hypoglycemia and do not decrease HbA1c levels.