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J Diabetes Investig. 2018;9(4):893-902.

Efficacy and safety of combination therapy with an α-glucosidase inhibitor and a dipeptidyl peptidase-4 inhibitor in patients with type 2 diabetes mellitus: A systematic review with meta-analysis.

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제1저자 민세희,윤정화 · 교신저자 한서경,조영민

PMID 28950431 PMC6031526 DOI 10.1111/jdi.12754 IF 3.6 내분비대사내과
소속 (3)
  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  2. Interdisciplinary Program in Medical Informatics, Seoul National University College of Medicine, Seoul, Korea.
  3. Department of Medicine, Seoul National University College of Medicine/Biostatistics Division of Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea.

Abstract

AIMS/INTRODUCTION The combination of dipeptidyl peptidase-4 (DPP4) inhibitors and α-glucosidase inhibitors (AGIs) might provide an additive or synergistic glucose-lowering effect, as they have a complementary mode of action. In the present study, we examined the efficacy and safety of the addition of a DPP4 inhibitor to patients with type 2 diabetes inadequately controlled with an AGI.

MATERIALS AND METHODS We carried out an electronic search of MEDLINE, EMBASE, the Cochrane Library and Clinicaltrials.gov through October 2016. Randomized controlled trials written in English that compared DPP4 inhibitors plus AGI (DPP4i/AGI) and placebo plus AGI (PCB/AGI) in patients with type 2 diabetes were selected. Data on the study characteristics, efficacy and safety outcomes were extracted, and the risk of potential biases was assessed. The efficacy and safety of DPP4i/AGI and PCB/AGI were compared.

RESULTS Of 756 potentially relevant published articles and 40 registered trials, five studies including 845 patients randomized to DPP4i/AGI and 832 patients randomized to PCB/AGI were included for meta-analysis. Compared with PCB/AGI, DPP4i/AGI showed a greater reduction in glycated hemoglobin (weighted mean difference -1.2%, 95% confidence interval -1.6 to -0.8), fasting plasma glucose and 2-h postprandial plasma glucose levels, with no increase in bodyweight. The risks of hypoglycemia and gastrointestinal adverse events were similar between DPP4i/AGI and PCB/AGI.

CONCLUSIONS The addition of a DPP4 inhibitor to patients with type 2 diabetes inadequately controlled with an AGI achieved better glycemic control without further increasing the risk of weight gain and hypoglycemia.

© 2017 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Keywords

Dipeptidyl peptidase-4 inhibitorType 2 diabetesα-Glucosidase inhibitor

Figures

Figure 1
Figure 1 Study selection process. RCT, randomized controlled trial.
Figure 2
Figure 2 Weighted mean difference in change in glycated hemoglobin levels from baseline. The change in glycated hemoglobin levels (%) from baseline with dipeptidyl peptidase‐4 inhibitor plus α‐glucosidase inhibitor (DPP4i/AGI) vs placebo plus α‐glucosidase inhibitor (PCB/AGI) analyzed using the random effects model. The squares indicate an individual study's effects, and the size of the squares corresponds to the study's weight in the meta‐analysis, with the horizontal lines extending from the symbols representing 95% confidence intervals (CI). The diamonds indicate pooled estimates.
Figure 3
Figure 3 Meta‐analysis for secondary efficacy outcomes. (a) Change in fasting plasma glucose (mg/dL) from baseline with dipeptidyl peptidase‐4 inhibitor plus α‐glucosidase inhibitor (DPP4i/AGI) vs placebo plus α‐glucosidase inhibitor (PCB/AGI) analyzed using the random effects model. (b) Change in 2‐h postprandial glucose (mg/dL) from baseline with DPP4i/AGI vs PCB/AGI analyzed using the random effects model. (c) Change in bodyweight (kg) from baseline with DPP4i/AGI vs PCB/AGI analyzed using the random effects model. The squares indicate an individual study's effects, and the size of the squares corresponds to the study's weight in the meta‐analysis, with the horizontal lines extending from the symbols representing 95% confidence intervals (CI). The diamonds indicate pooled estimates.
Figure 4
Figure 4 Meta‐analysis for safety outcomes. (a) Relative risk of hypoglycemia with dipeptidyl peptidase‐4 inhibitor plus α‐glucosidase inhibitor (DPP4i/AGI) vs placebo plus α‐glucosidase inhibitor (PCB/AGI) analyzed using the random effects model. (b) Relative risk (RR) of gastrointestinal adverse events with DPP4i/AGI vs PCB/AGI analyzed using the random effects model. The squares indicate an individual study's effects, and the size of the squares corresponds to the study's weight in the meta‐analysis, with the horizontal lines extending from the symbols representing 95% confidence intervals (CI). The diamonds indicate pooled estimates.

그림 출처: PubMed Central 공개 논문 (PMC6031526)

그 밖의 정보
출판 형태
Journal Article, Meta-Analysis, Systematic Review
저널
Journal of diabetes investigation · eISSN 2040-1124
전자 출판
2017-10-25
MeSH
Adult · Diabetes Mellitus, Type 2 / drug therapy · Dipeptidyl-Peptidase IV Inhibitors / therapeutic use · Female · Glycoside Hydrolase Inhibitors / therapeutic use · Humans · Hypoglycemic Agents / therapeutic use · Male · Middle Aged · Randomized Controlled Trials as Topic · Treatment Outcome
Substances
Dipeptidyl-Peptidase IV Inhibitors · Glycoside Hydrolase Inhibitors · Hypoglycemic Agents
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