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

• Published in: Journal of diabetes investigation 2018-07, Vol.9 (4), p.893-902
• Main Authors: Min, Se Hee, Yoon, Jeong‐Hwa, Hahn, Seokyung, Cho, Young Min
• Format: Article
• Language: English
• Subjects: Adult; Body weight gain; Clinical trials; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Dipeptidyl peptidase‐4 inhibitor; Dipeptidyl-peptidase IV; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; Female; Glucose; Glycoside Hydrolase Inhibitors - therapeutic use; Hemoglobin; Humans; Hypoglycemia; Hypoglycemic Agents - therapeutic use; Male; Meta-analysis; Middle Aged; Original; PCB; Peptidase; Polychlorinated biphenyls; Randomized Controlled Trials as Topic; Safety; Treatment Outcome; Type 2 diabetes; α-Glucosidase; α‐Glucosidase inhibitor
• ISSN: 2040-1116; 2040-1124
• DOI: 10.1111/jdi.12754

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. We performed a systematic review and meta‐analysis to examine the efficacy and safety of a combination of a dipeptidyl peptidase‐4 inhibitor and an alpha‐glucosidase inhibitor in patients with inadequately controlled type 2 diabetes. Our results indicate that combination therapy improves glycemic control without further increasing the risk of weight gain and hypoglycemia.