Article (Scientific journals)
Reduction in HbA1c with SGLT2 inhibitors vs. DPP-4 inhibitors as add-ons to metformin monotherapy according to baseline HbA1c: A systematic review of randomized controlled trials.
Scheen, André
2020In Diabetes & metabolism
Peer reviewed
 

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Keywords :
DPP-4 inhibitor; Glucose control; HbA1c; Metformin; SGLT2 inhibitor; Type 2 diabetes
Abstract :
[en] AIMS: This study compared the reduction of glycated haemoglobin (HbA1c) with sodium-glucose cotransporter type-2 inhibitors (SGLT2is) vs. dipeptidyl peptidase-4 inhibitors (DPP-4is) as add-ons to metformin in patients with type 2 diabetes mellitus (T2DM), with a specific focus on HbA1c changes according to baseline HbA1c. MATERIALS AND METHODS: Electronic databases were scrutinized for randomized controlled trials (RCTs) evaluating the reduction of HbA1c from baseline (Delta HbA1c) with an SGLT2i or DPP-4i in patients with T2DM not well controlled by metformin monotherapy. The endpoint was Delta HbA1c using both indirect and direct comparisons. RESULTS: Overall, Delta HbA1c was slightly greater with SGLT2is (-0.80+/-0.20% from 8.03+/-0.35%; 44 analyses, 29 RCTs, 15 with two doses, n=9321) than with DPP-4is (-0.71+/-0.23% from 8.05+/-0.43%; 61 analyses, 59 RCTs, n=17,914; P=0.0354). When the mean baseline HbA1c was<8% ([64mmol/mol] 7.79+/-0.15% vs. 7.71+/-0.23%), Delta HbA1c averaged -0.735+/-0.17% vs. -0.62+/-0.16% (P=0.0117) with SGLT2is vs. DPP-4is, respectively. However, this difference vanished when the mean baseline HbA1c was>/=8% (-0.87+/-0.22% from 8.27+/-0.32% with SGLT2is vs. -0.80+/-0.24% from 8.35+/-0.33% with DPP-4is; P=0.2756). The relationship between Delta HbA1c and baseline HbA1c was only slightly stronger with SGLT2is (slope: -0.39, r(2)=-0.43; P<0.0001) than with DPP-4is (slope: -0.26, r(2)=-0.25; P<0.0001). CONCLUSION: Because of the small difference in Delta HbA1c whatever the baseline HbA1c level with SGLT2is vs. DPP-4is as add-ons to metformin, choosing between these glucose-lowering agents in clinical practice should be based on other efficacy criteria (such as weight and blood pressure changes, cardiovascular and renal protection) or on safety profiles rather than on HbA1c levels.
Disciplines :
Endocrinology, metabolism & nutrition
Pharmacy, pharmacology & toxicology
Author, co-author :
Scheen, André  ;  Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Language :
English
Title :
Reduction in HbA1c with SGLT2 inhibitors vs. DPP-4 inhibitors as add-ons to metformin monotherapy according to baseline HbA1c: A systematic review of randomized controlled trials.
Publication date :
2020
Journal title :
Diabetes & metabolism
ISSN :
1262-3636
eISSN :
1878-1780
Peer reviewed :
Peer reviewed
Commentary :
Copyright (c) 2020 Elsevier Masson SAS. All rights reserved.
Available on ORBi :
since 23 April 2020

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