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Review
. 2015 Nov 1;8(11):14141-50.
eCollection 2015.

Assessing the efficacy and safety of combined DPP-4 inhibitor and insulin treatment in patients with type 2 diabetes: a meta-analysis

Cai Chen  1 , Qilin Yu  1 , Shu Zhang  1 , Ping Yang  1 , Cong-Yi Wang  1
Affiliations
Review

Assessing the efficacy and safety of combined DPP-4 inhibitor and insulin treatment in patients with type 2 diabetes: a meta-analysis

Cai Chen et al. Int J Clin Exp Pathol. .

Abstract

The use of DPP-4 inhibitors in combination with insulin has been proposed as an alternative therapeutic option for poorly controlled type 2 diabetes (T2D) patients. We thus performed a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy and safety of this combination therapy in adult T2D patients. Seven eligible studies involving 3,384 participants were included for the study. The resulting data revealed that the combination therapy of DPP-4 inhibitor and insulin is associated with a modest reduction in HbA1c (-0.52%; 95% CI -0.59 to -0.44), a decrease in 2h-PPG (-1.81 mmol/l; -2.23 to -1.38), and an increase in the proportion of patients reaching the target HbA1c of ≤ 7% (RR 2.24; 95% CI 1.80 to 2.77) without increasing the risk of hypoglycemia (RR 1.04; 0.83 to 1.31) or body weight (-0.11 kg; -0.56 to 0.33), as compared with other anti-diabetic treatments. These results support that this combination therapy could serve as a potential therapeutic strategy that offers an alternative option for patients inadequately controlled on other anti-diabetic agents in clinical practice.

Keywords: DPP-4 inhibitors; hypoglycemia; insulin; type 2 diabetes; weight gain.

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Figures

Figure 1
Figure 1
Flow chart for the selection of literatures.
Figure 2
Figure 2
Funnel plot with Egger’s test was employed to assess the risk of publication bias for the changes in (A) body weight (kg), (B) HbA1c (%), (C) FPG (mmol/l), (D) PPG (mmol/l), (E) relative risk for HAb1c ≤ 7.0%, and (F) relative risk for hypoglycemia episodes.
Figure 3
Figure 3
Outcomes for the comparison of body weight (A) and HbA1c (%) (B) of combination therapy (DPP-4 inhibitors and insulin) with placebo or other anti-diabetic agents in patients with type 2 diabetes by Forest plots.
Figure 4
Figure 4
Results assessed by Forest plots for the combination treatment of DPP4 inhibitors and insulin with placebo or other anti-diabetic agents in T2D patients for FPG (mmol/l) (A) and PPG (mmol/l) (B).
Figure 5
Figure 5
Relative risks assessed by Forest plots in terms of failing to reach HAb1c ≤ 7.0% (A), and the episodes for developing hypoglycemia (B).
See this image and copyright information in PMC

References

    1. DeFronzo RA. Pathogenesis of type 2 diabetes mellitus. Med Clin North Am. 2004;88:787–835. ix. - PubMed
    1. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR American Diabetes Association (ADA); European Association for the Study of Diabetes (EASD) Management of hyperglycemia in type 2 diabetes: a patientcentered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Diabetes Care. 2012;35:1364–1379. - PMC - PubMed
    1. Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA. 1999;281:2005–2012. - PubMed
    1. Korytkowski M. When oral agents fail: practical barriers to starting insulin. Int J Obes Relat Metab Disord. 2002;26(Suppl 3):S18–24. - PubMed
    1. Guler S, Vaz JA, Ligthelm R. Intensification lessons with modern premixes: from clinical trial to clinical practice. Diabetes Res Clin Pract. 2008;81(Suppl 1):S23–30. - PubMed

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