PMID- 23803146
OWN - NLM
STAT- MEDLINE
DCOM- 20141028
LR  - 20221207
IS  - 1463-1326 (Electronic)
IS  - 1462-8902 (Linking)
VI  - 16
IP  - 1
DP  - 2014 Jan
TI  - Efficacy and safety of dipeptidyl peptidase-4 inhibitors and metformin as initial 
      combination therapy and as monotherapy in patients with type 2 diabetes mellitus: 
      a meta-analysis.
PG  - 30-7
LID - 10.1111/dom.12174 [doi]
AB  - AIMS: This meta-analysis was performed to provide an update on the efficacy and 
      safety of dipeptidyl peptidase-4 (DPP-4) inhibitors and metformin as initial 
      combination therapy and as monotherapy in patients with type 2 diabetes mellitus 
      (T2DM). METHODS: We conducted a search on MEDLINE, Embase and Cochrane 
      Collaborative database for randomized controlled trials (RCTs) of DPP-4 
      inhibitors and metformin as initial combination therapy or as monotherapy in 
      patients with T2DM by the end of December 2012, using the key words 'alogliptin', 
      'dutogliptin', 'linagliptin', 'saxagliptin', 'sitagliptin', 'vildagliptin' and 
      'metformin'. RCTs were selected for meta-analysis if (1) they were RCTs comparing 
      DPP-4 inhibitors plus metformin as initial combination therapy or DPP-4 inhibitor 
      monotherapy to metformin monotherapy, (2) duration of treatment was >/=12 weeks and 
      (3) reported data on haemoglobin A1c (HbA1c) change, fasting plasma glucose (FPG) 
      change, weight change, adverse cardiovascular (CV) events, hypoglycaemia or 
      gastrointestinal adverse events (AEs). RESULTS: A total of eight RCTs were 
      included. Compared with metformin monotherapy, DPP-4 inhibitors monotherapy was 
      associated with lower reduction in HbA1c level [weighted mean differences 
      (MD) = 0.28, 95% confidence intervals (CIs) (0.17, 0.40), p < 0.00001], lower 
      reduction in FPG level [MD = 0.81, 95% CI(0.60, 1.02), p <0.00001], lower weight 
      loss [MD = 1.51, 95% CI (0.89, 2.13), p < 0.00001], but lower risk of adverse CV 
      events [risk ratio (RR) = 0.36, 95% CI (0.15, 0.85), p = 0.02], lower risk of 
      hypoglycaemia [RR = 0.44, 95% CI (0.27, 0.72), p = 0.001] and lower risk of 
      gastrointestinal AEs [RR = 0.63, 95% CI(0.55, 0.70), p <0.00001]. Compared with 
      metformin monotherapy, DPP-4 inhibitors plus metformin as initial combination 
      therapy was associated with higher reduction in HbA1c level [MD = -0.49, 95% CI 
      (-0.57, -0.40), p < 0.00001], higher reduction in FPG level [MD = -0.80, 95% CI 
      (-0.87, -0.74), p < 0.00001], lower weight loss [MD = 0.44, 95% CI (0.22, 0.67), 
      p = 0.0001]; but was not associated with a further reduction in adverse CV events 
      [RR=0.54, 95% CI (0.25, 1.19), p = 0.13], nor the higher risk of hypoglycaemia 
      [RR = 1.04, 95% CI (0.72, 1.50), p = 0.82], nor the prolonged risk of 
      gastrointestinal AEs [RR = 0.98, 95% CI (0.88, 1.10), p = 0.77]. CONCLUSIONS: 
      DPP-4 inhibitors, which are safe and effective in controlling the blood glucose, 
      may possibly decrease the risk of CV events in patients with T2DM. It could be a 
      credible alternative for T2DM patients who, for some reason, cannot use 
      metformin, or are in high risk of CV exposure. High-quality, large sample and 
      long-term follow-up clinical trails are needed to confirm the long-term 
      conclusions.
CI  - (c) 2013 John Wiley & Sons Ltd.
FAU - Wu, D
AU  - Wu D
AD  - Department of Endocrinology, Shengjing Hospital of China Medical University, 
      Shenyang, Liaoning Province, China.
FAU - Li, L
AU  - Li L
FAU - Liu, C
AU  - Liu C
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20130716
PL  - England
TA  - Diabetes Obes Metab
JT  - Diabetes, obesity & metabolism
JID - 100883645
RN  - 0 (Blood Glucose)
RN  - 0 (Dipeptidyl-Peptidase IV Inhibitors)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (hemoglobin A1c protein, human)
RN  - 9100L32L2N (Metformin)
SB  - IM
MH  - Blood Glucose/metabolism
MH  - Body Weight
MH  - Diabetes Mellitus, Type 2/blood/*drug therapy
MH  - Dipeptidyl-Peptidase IV Inhibitors/adverse effects/*pharmacology/therapeutic use
MH  - Drug Therapy, Combination
MH  - Fasting
MH  - Female
MH  - Glycated Hemoglobin/metabolism
MH  - Humans
MH  - Hypoglycemia/blood/*chemically induced/prevention & control
MH  - Hypoglycemic Agents/adverse effects/*pharmacology/therapeutic use
MH  - Male
MH  - Metformin/adverse effects/*pharmacology/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
OTO - NOTNLM
OT  - dipeptidyl peptidase-4 inhibitors
OT  - linagliptin
OT  - meta-analysis
OT  - metformin
OT  - saxagliptin
OT  - sitagliptin
OT  - type 2 diabetes mellitus
OT  - vildagliptin
EDAT- 2013/06/28 06:00
MHDA- 2014/10/29 06:00
CRDT- 2013/06/28 06:00
PHST- 2013/02/05 00:00 [received]
PHST- 2013/03/26 00:00 [revised]
PHST- 2013/06/19 00:00 [accepted]
PHST- 2013/06/28 06:00 [entrez]
PHST- 2013/06/28 06:00 [pubmed]
PHST- 2014/10/29 06:00 [medline]
AID - 10.1111/dom.12174 [doi]
PST - ppublish
SO  - Diabetes Obes Metab. 2014 Jan;16(1):30-7. doi: 10.1111/dom.12174. Epub 2013 Jul 
      16.