The efficacy and safety of DPP4 inhibitors in patients with type 1 diabetes: A systematic review and meta-analysis

Diabetes Res Clin Pract. 2016 Nov;121:184-191. doi: 10.1016/j.diabres.2016.08.022. Epub 2016 Sep 28.

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 -2.41U/day, 95% CI [-3.87, -0.94], P=0.001) but did not reduce HbA1c level (MD 0.0% (0mmol/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.

Keywords: DPP4 inhibitors; Meta-analysis; Type 1 diabetes.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Dipeptidyl-Peptidase IV Inhibitors / therapeutic use*
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • Hypoglycemic Agents / therapeutic use

Substances

  • Dipeptidyl-Peptidase IV Inhibitors
  • Glycated Hemoglobin A
  • Hypoglycemic Agents