Effect of DPP-IV Inhibitors on Glycemic Variability in Patients with T2DM: A Systematic Review and Meta-Analysis

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.

Association between the Use of Dipeptidyl Peptidase 4 Inhibitors and the Risk of Dementia among Patients with Type 2 Diabetes in Taiwan

“…In addition, glycemic fluctuations might contribute to poor cognitive outcomes [43]. On the other hand, compared with other oral antidiabetic agents, especially sulfonylureas, DPP-4i provides steady glucose variability [44,45]. Accordingly, our study results demonstrate the independent benefits of DPP-4i use in preserving the cognitive function of patients with diabetes.…”

Glycemic Variability Impacted by SGLT2 Inhibitors and GLP 1 Agonists in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis

“…Although SGLT-2 inhibitors and GLP-1 agonists were more effective against GV fluctuations than other drugs, certain aspects must be elucidated. A meta-analysis revealed that dipeptidyl peptidase IV inhibitor (DPP-4) inhibitors were significantly more effective than other oral antihyperglycemic drugs at reducing GV in patients with type 2 diabetes [ 39 ]. However, the effects of DPP-4 inhibitors on cardiovascular outcomes are considered neutral [ 39 , 40 , 41 ].…”

“…A meta-analysis revealed that dipeptidyl peptidase IV inhibitor (DPP-4) inhibitors were significantly more effective than other oral antihyperglycemic drugs at reducing GV in patients with type 2 diabetes [ 39 ]. However, the effects of DPP-4 inhibitors on cardiovascular outcomes are considered neutral [ 39 , 40 , 41 ]. This could lead to reasonable doubt about the effect of GV on cardiovascular outcomes.…”

Low dose allopurinol is associated with modest but significant improvements in glycemic control (GC) and glycemic variability (GV) in patients with type 2 diabetes mellitus: A cross-sectional study

“…For example, one recent study assessed the prognostic signi cance of GV calculated from HbA1c vs that calculated from FBS and found that GV parameters calculated from FBS readings were more consistent with the metabolic outcomes and complications (10). There also are statistical considerations and methodological considerations (33). However, in an attempt to relate the results obtained in this study to a reference method, the ALLHAT study suggested that VIM is possibly the most robust measure of GV insofar as each unit change in VIM was associated with a higher risk of death; HR 1.014 (95% CI 1.006-1.022)(P = 0.001)(8).…”