Abstract
Glycemic variability (GV) has been an emerging target for preventing complications related to type 2 diabetes. For reducing GV, DPP-IV inhibitors have shown effectiveness compared to other oral anti-hyperglycemic drugs (OADs), but systematic evaluation has yet to be existed. A systematic review and meta-analysis of randomized controlled trials (RCTs) were performed to evaluate the effect of DPP-IV inhibitors compared with other OADs, on GV as measured by mean amplitude of glycemic excursions (MAGE). Searches were conducted using Pubmed, EMBASE, and the Cochrane Library, from which eligible studies were retrieved; seven RCTs were included in the analysis. DPP-IV inhibitors were found to significantly reduce MAGE compared to other OADs (mean difference = −14.61; 95% CI = −19.00 to −10.21; p < 0.0001) without significant heterogeneity among sulfonylureas (mean difference = −14.93; 95% CI = −21.60 to −8.26; p < 0.0001). Initial combination therapy with DPP-IV inhibitors more effectively reduced MAGE than stepwise add-on therapies (p = 0.006), although no differences in MAGE were found based on HbA1c values. These findings indicate that DPP-IV inhibitors are promising alternatives for reducing GV in type 2 diabetes patients. However, further studies utilizing larger numbers of patients and longer-term follow-ups are needed.
Highlights
Unregulated hyperglycemia in diabetic patients is associated with increased diabetic complications such as cardiovascular disease[1] that has resulted in an additional 2.2 million deaths[2]
Four studies[9,13,15,16] added Dipeptidyl-peptidase IV (DPP-IV) inhibitors or other oral antihyperglycemic drugs (OADs) to metformin as stepwise add-on therapy for treating type 2 diabetes mellitus (T2DM) patients
The current study showed DPP-IV inhibitors significantly reduced Glycemic variability (GV) compared to other OADs in T2DM patients
Summary
Unregulated hyperglycemia in diabetic patients is associated with increased diabetic complications such as cardiovascular disease[1] that has resulted in an additional 2.2 million deaths[2]. To reduce such risks, glucose variability (GV), the term for glycemic fluctuation, has emerged as an important clinical predictor and an essential target for dysglycemia treatment in diabetic patients[3]. Dipeptidyl-peptidase IV (DPP-IV) inhibitors have been found to reduce blood glucose fluctuations and improve glycemic control in type 2 diabetes mellitus (T2DM) patients. For reducing GV, clinical trials conducted with DPP-IV inhibitors provided discriminated outcomes of efficacy compared with other OADs9,10. Available randomized controlled trials (RCTs), was performed to provide more evidence with higher statistical power regarding the impact of DPP-IV inhibitors on GV in patients with T2DM
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