Dipeptidyl peptidase‐4 inhibitor and insulin combination treatment in type 2 diabetes and chronic kidney disease: A meta‐analysis

• Published in: Journal of diabetes investigation 2022-03, Vol.13 (3), p.468-477
• Main Authors: Zhou, Xianling, Shi, Heng, Zhu, Shiping, Wang, Haixia, Sun, Shengyun
• Format: Article
• Language: English
• Subjects: Bias; Cholesterol; Chronic kidney disease; Clinical trials; Collaboration; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Dipeptidyl peptidase‐4 inhibitor; Dipeptidyl-peptidase IV; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; Dipeptidyl-Peptidases and Tripeptidyl-Peptidases - therapeutic use; Drug dosages; Glomerular filtration rate; Glucose; Glycated Hemoglobin - therapeutic use; Hemodialysis; Hemoglobin; Humans; Hypoglycemia; Hypoglycemic Agents - therapeutic use; Insulin; Insulin - therapeutic use; Kidney diseases; Meta-analysis; Original; Patients; Peptidase; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - drug therapy; Treatment Outcome; Type 2 diabetes; Uric acid; Working groups
• ISSN: 2040-1116; 2040-1124; 2040-1124
• DOI: 10.1111/jdi.13675

ABSTRACT Aims/Introduction The union of dipeptidyl peptidase‐4 inhibitors and insulin in patients with type 2 diabetes and chronic kidney disease provides satisfactory glucose management without increasing adverse events (AEs). This research appraised the therapeutic effect and safety of combination therapy in patients with type 2 diabetes and chronic kidney disease. Materials and Methods We carried out a meta‐analysis of randomized controlled trials to analyze AEs, hypoglycemia, serious AEs, severe hypoglycemia, estimated glomerular filtration rate, fasting plasma glucose, glycated hemoglobin, insulin dose, low‐density lipoprotein cholesterol, uric acid and weight between combination treatment groups and control groups by searching the Cochrane Library, Excerpta Medica Database (Embase), PubMed and Web of Science databanks until October 2020. Results Five studies (6 trials, 1,278 participants) met the inclusion criteria. The evidence quality ranged from moderate to high. Glycated hemoglobin (standardized mean difference −0.29, 95% confidence interval −0.44 to −0.14) and insulin dose (standardized mean difference −0.16, 95% confidence interval −0.29 to −0.02) were obviously smaller in the combination cure patients than in the control patients. Compared with the control groups, combination treatment did not increase AEs, hypoglycemia, serious AEs or severe hypoglycemia. Conclusions This study showed the effectiveness and safety of dipeptidyl peptidase‐4 inhibitors bonded with insulin in patients with type 2 diabetes and chronic kidney disease, but the protective actions of this cure on kidney and cardiovascular outcomes, as well as the functions of other dipeptidyl peptidase‐4 inhibitors, need to be affirmed by more good‐quality randomized controlled trials. It is difficult to control blood glucose in patients with type 2 diabetes complicated with chronic kidney disease, and they are more likely to have adverse events, such as hypoglycemia. Dipeptidyl peptidase‐4 inhibitors combined with insulin can reduce glycated hemoglobin and insulin dose in patients with type 2 diabetes complicated with chronic kidney disease, and there is no significant increase in the incidence of adverse events, such as hypoglycemia. This study provides strong evidence for the application of dipeptidyl peptidase‐4 inhibitors combined with insulin in patients with type 2 diabetes complicated with chronic kidney disease.