PMID- 23810103
OWN - NLM
STAT- MEDLINE
DCOM- 20131029
LR  - 20240321
IS  - 2046-4053 (Electronic)
IS  - 2046-4053 (Linking)
VI  - 2
DP  - 2013 Jun 28
TI  - Safety, effectiveness, and cost of dipeptidyl peptidase-4 inhibitors versus 
      intermediate acting insulin for type 2 diabetes: protocol for a systematic review 
      and network meta-analysis.
PG  - 47
LID - 10.1186/2046-4053-2-47 [doi]
AB  - BACKGROUND: Type 2 diabetes mellitus (T2DM) results from insulin resistance and 
      relative insulin deficiency. T2DM treatment is a step-wise approach beginning 
      with lifestyle modifications (for example, diet, exercise), followed by the 
      addition of oral hypoglycemic agents (for example, metformin). Patients who do 
      not respond to first-line therapy are offered second-line therapy (for example, 
      sulfonylureas). Third-line therapy may include insulin and/or dipeptidyl 
      peptidase-4 (DPP-4) inhibitors.It is unclear whether DPP-4 inhibitors are safer 
      and more effective than intermediate acting insulin for third-line management of 
      T2DM. As such, our objective is to evaluate the comparative effectiveness, safety 
      and cost-effectiveness of DPP-4 inhibitors versus intermediate acting insulin for 
      T2DM patients who have failed both first- and second-line diabetes treatments. 
      DESIGN/METHODS: Electronic searches of MEDLINE, Cochrane Central Register of 
      Controlled Trials, EMBASE, and grey literature (for example, trial registries, 
      public health websites) will be conducted to identify studies examining DPP-4 
      inhibitors compared with each other, intermediate acting insulin, no treatment, 
      or placebo for adults with T2DM. The outcomes of interest include glycosylated 
      hemoglobin (A1C) (primary outcome), as well as emergency department visits, 
      physician visits, hospital admissions, weight gain, quality of life, 
      microvascular complications, macrovascular complications, all-cause mortality, 
      and cost (secondary outcomes). Randomized clinical trials (RCTs), quasi-RCTs, 
      non-RCTs, controlled before-after, interrupted time series, cohort studies, and 
      cost studies reporting data on these outcomes will be included. Eligibility will 
      not be restricted by publication status, language of dissemination, duration of 
      study follow-up, or time period of study conduct.Two reviewers will screen the 
      titles and abstracts resulting from the literature search, as well as potentially 
      relevant full-text articles, in duplicate. Data will be abstracted and quality 
      will be appraised by two team members independently. Conflicts at all levels of 
      screening and abstraction will be resolved through team discussion.Our results 
      will be described narratively. Random effects meta-analysis and network 
      meta-analysis will be conducted, if feasible and appropriate. DISCUSSION: Our 
      systematic review results can be used to determine the most effective, safe and 
      cost-effective third-line strategies for managing T2DM. This information will be 
      of great use to health policy-makers and clinicians, as well as patients living 
      with T2DM and their families. TRIAL REGISTRATION: PROSPERO registry number: 
      CRD42013003624.
FAU - Tricco, Andrea C
AU  - Tricco AC
AD  - Li Ka Shing Knowledge Institute, St, Michael's Hospital, 209 Victoria Street, 
      East Building, Toronto, Ontario M5B 1T8, Canada.
FAU - Antony, Jesmin
AU  - Antony J
FAU - Soobiah, Charlene
AU  - Soobiah C
FAU - Hemmelgarn, Brenda
AU  - Hemmelgarn B
FAU - Moher, David
AU  - Moher D
FAU - Hutton, Brian
AU  - Hutton B
FAU - Yu, Catherine H
AU  - Yu CH
FAU - Majumdar, Sumit R
AU  - Majumdar SR
FAU - Straus, Sharon E
AU  - Straus SE
LA  - eng
GR  - Canadian Institutes of Health Research/Canada
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130628
PL  - England
TA  - Syst Rev
JT  - Systematic reviews
JID - 101580575
RN  - 0 (Dipeptidyl-Peptidase IV Inhibitors)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
SB  - IM
MH  - Cost-Benefit Analysis
MH  - Diabetes Mellitus, Type 2/*drug therapy
MH  - Dipeptidyl-Peptidase IV Inhibitors/adverse effects/*therapeutic use
MH  - Glycated Hemoglobin/metabolism
MH  - Humans
MH  - Hypoglycemic Agents/adverse effects/therapeutic use
MH  - Insulin/adverse effects/*therapeutic use
MH  - *Meta-Analysis as Topic
MH  - *Outcome Assessment, Health Care
MH  - *Research Design
MH  - Safety
MH  - *Systematic Reviews as Topic
PMC - PMC3702520
EDAT- 2013/07/03 06:00
MHDA- 2013/10/30 06:00
PMCR- 2013/06/28
CRDT- 2013/07/02 06:00
PHST- 2013/02/25 00:00 [received]
PHST- 2013/03/07 00:00 [accepted]
PHST- 2013/07/02 06:00 [entrez]
PHST- 2013/07/03 06:00 [pubmed]
PHST- 2013/10/30 06:00 [medline]
PHST- 2013/06/28 00:00 [pmc-release]
AID - 2046-4053-2-47 [pii]
AID - 10.1186/2046-4053-2-47 [doi]
PST - epublish
SO  - Syst Rev. 2013 Jun 28;2:47. doi: 10.1186/2046-4053-2-47.