Comparisons of the efficacy of glucose control, lipid profile, and β-cell function between DPP-4 inhibitors and AGI treatment in type 2 diabetes patients: a meta-analysis

The aim of this study is to compare the efficacy of dipeptidyl peptidase-4 (DPP-4) inhibitor treatment with α-glucosidase inhibitor (AGI) treatment in patients with type 2 diabetes through a meta-analysis. Studies were identified by a literature search of Medline, Embase, and others from the time that recording commenced until December 2014. The meta-analysis was performed by computing the weighted mean difference (WMD) and 95 % confidence interval (CI) for a change from baseline to the study endpoint for DPP-4 inhibitors versus AGIs. Nine randomized controlled trial were judged to be appropriate for inclusion in the meta-analysis. One thousand and forty-six patients were treated with a DPP-4 inhibitor, while 929 patients were treated with AGI treatment; the groups had a comparable baseline body mass index of 25.5 ± 1.3 kg/m² and mean baseline HbA_1c of 7.83 ± 0.53 %. Treatment with DPP-4 inhibitors led to a significantly greater change from baseline in the HbA_1c levels (WMD −0.30 %; 95 % CI −0.47 to −0.13 %, p < 0.001) and fasting plasma glucose levels (WMD −0.50 mmol/L; 95 % CI −0.89 to −0.11 mmol/L, p = 0.01) compared with AGI treatment. Compared with AGIs, treatment with DPP-4 inhibitors was associated with a significantly greater increase in the weight change from baseline (WMD 0.89 kg; 95 % CI 0.53–1.25, p < 0.001). Treatment with DPP-4 inhibitors was associated with a significantly greater increase in the fasting insulin level from baseline (WMD 0.63 µU/mL; 95 % CI 0.35–0.90 µU/mL, p < 0.001). DPP-4 inhibitors significantly improved homeostatic model assessment for β-cell function in type 2 diabetes patients compared with AGI treatment (WMD 5.43; 95 % CI 1.01–9.85, p = 0.02). DPP-4 inhibitors were associated with a significantly greater decrease in the cholesterol (CHO) level (WMD −0.19 mmol/L; 95 % CI −0.19 to −0.19 mmol/L, p < 0.001) and a significantly greater decrease in the low-density lipoprotein cholesterol (LDL-C) level (WMD −0.16 mmol/L; 95 % CI −0.26 to −0.05 mmol/L, p = 0.003). Compared with AGIs (813 participants), treatment with DPP-4 inhibitors (1031 participants) was associated with a significantly lower incidence of drug-related adverse event (OR 0.48; 95 % CI 0.36–0.64, p < 0.0001). The efficacy of glucose control and improvement of β-cell function, as well as total CHO and LDL-C decreases, in DPP-4 inhibitor treatment were superior to those with AGI treatment, and there was a lower incidence of drug-related AE.