Efficacy and safety of sodium‐glucose cotransporter‐2 inhibitors versus dipeptidyl peptidase‐4 inhibitors as monotherapy or add‐on to metformin in patients with type 2 diabetes mellitus: A A systematic review and meta‐analysis

摘要

Aims To compare the efficacy and safety of dipeptidyl peptidase‐4 inhibitors ( DPP ‐4is) and sodium‐glucose cotransporter‐2 inhibitors ( SGLT ‐2is) as monotherapy or add‐on to metformin ( M et) in patients with type 2 diabetes mellitus ( T2DM ). Materials and Methods PubMed , E mbase and ClinicalTrials.gov sites were systematically searched for randomized controlled trials to assess the efficacy and safety of DPP ‐4is and SGLT ‐2is in patients with T2DM . R isk ratio ( RR ) and weighted mean difference ( WMD ) were used to evaluate outcomes. Results In the analysis of 25 randomized trials, which involved 14?619 patients, SGLT ‐2is were associated with a significantly stronger reduction in haemoglobin A 1c ( HbA1c ) ( WMD 0.13%, 95% credible interval [ CI ], 0.04%‐0.22%, P ?=?.005) and fasting plasma glucose ( FPG ) ( WMD 0.80?mmol/L, 95% CI , 0.58‐1.01?mmol/L, P ??.00001) than were DPP ‐4is. However, no significant difference between the 2 drug categories was found in the risk of hypoglycaemic events ( RR , 0.99; 95% CI , 0.78‐1.26, P ?=?.92). SGLT ‐2is plus M et was associated with a more significant decrease in FPG ( WMD 0.71?mmol/L, 95% CI , 0.43‐1.00?mmol/L, P ??.00001) than was DPP ‐4is plus M et. However, no differences were found in the reduction of HbA1c ( WMD 0.11%, 95% CI , ?0.03%‐0.25%, P ?=?.12) or the risk of hypoglycaemic events ( RR , 1.02; 95% CI, 0.80‐1.31, P ?=?.86). Conclusions This review revealed that, compared to DPP ‐4is, SGLT ‐2is significantly reduced HbA1c , FPG and body weight without increasing the risk of hypoglycaemia in diabetes treatment.