Effects of GLP-1 Receptor Agonists versus DPP-4 Inhibitors for Type 2 Diabetes Mellitus: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHOUYue , HEMei , YANGMing ,  LIUFu

Department of Pharmacy, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China;

Corresponding?author：

LIUFu, Email: nclf91@163.com

Keywords：

Exenatide; Liraglutide; Sitagliptin; GLP-1 receptor agonist; DPP-4 inhibitor; Type 2 diabetes mellitus; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20140234

Video：

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Objective To systematically review the effectiveness and safety of GLP-1 receptor agonists versus DPP-4 inhibitors for type 2 diabetes mellitus (T2DM). Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 4, 2013), WanFang Data, CBM and CNKI were searched electronically for randomized controlled trials (RCTs) about GLP-1 receptor agonists versus DPP-4 inhibitors for T2DM up to April 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2.5 software. Results A total of 4 RCTs was included. The results of meta-analysis showed that:compared with DPP-4 inhibitors, GLP-1 receptor agonists were more effective in reducing levels of glycated hemoglobin (MD=-0.46, 95%CI-0.57 to-0.35, P < 0.000 01), fasting blood glucose (MD=-1.13, 95%CI-1.39 to-0.88, P < 0.000 01), and weight (MD=-1.59, 95%CI-1.99 to-1.19, P < 0.000 01). In addition, T2DM patients taking GLP-1 receptor agonists had significantly higher achievement rates of glycosylated haemoglobin ( < 7% and≤6.5%), and higher incidences of nausea (OR=4.31, 95%CI 2.87 to 6.47, P < 0.000 01) and diarrhea (OR=2.11, 95%CI 1.40 to 3.18, P=0.000 4). Conclusion GLP-1 receptor agonists are superior to DPP-4 inhibitors in controlling T2DM patients' levels of blood glucose and reducing weight, but it has more gastrointestinal adverse reaction.

Citation： ZHOUYue, HEMei, YANGMing, LIUFu. Effects of GLP-1 Receptor Agonists versus DPP-4 Inhibitors for Type 2 Diabetes Mellitus: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(12): 1459-1466. doi: 10.7507/1672-2531.20140234 Copy

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2.	張立宏, 王莉莉, 李松.二肽基肽酶-Ⅳ抑制劑藥理學作用及機制的研究進展.中國新藥雜志.2009, 18(11):1000-1004.
3.	周映紅, 黃文龍, 張惠斌, 等. GLP-1受體激動劑及DPP-Ⅳ抑制劑的研究進展.中國藥科大學學報. 2008, 39(5):385-391.
4.	凌雪梅, 楊春霞.沙格列汀改善2型糖尿病患者β細胞功能的Meta分析.中國循證醫學雜志. 2013, 13(4):436-440.
5.	李吉, 孫家忠, 李廣森, 等.西格列汀聯合二甲雙胍治療2型糖尿病效果的系統評價.中國循證醫學雜志. 2013, 13(7):836-843.
6.	占美, 吳逢波, 黃晶, 等.維格列汀改善2型糖尿病患者B細胞功能的Meta分析.中國藥房, 2012, 23(6):555-557.
7.	Aaboe K, Knop FK, Vilsb?ll T, et al. Twelve weeks treatment with the DPP-4 inhibitor, sitagliptin, prevents degradation of peptide YY and improves glucose and non-glucose induced insulin secretion in patients with type 2 diabetes mellitus. Diabetes Obes Metab, 2010, 12(4):323-333.
8.	顏新, 鄧宏明, 肖常青, 等.利拉魯肽治療2型糖尿病的系統評價.循證醫學, 2012, 12(2):117-124.
9.	Fakhoury WK, Lereun C, Wright D. A meta-analysis of placebo-controlled clinical trials assessing the efficacy and safety of incretin-based medications in patients with type 2 diabetes. Pharmacology, 2010, 86(1):44-57.
10.	占美, 吳逢波, 吳斌, 等.沙格列汀治療糖尿病安全性的系統評價.中國醫院藥學雜志, 2012, 32(12):940-943.
11.	Puavilai G, Chanprasertyotin S, Sriphrapradaeng A. Diagnostic criteria for diabetes mellitus and other categories of glucose intolerance:1997 criteria by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (ADA), 1998 WHO consultation criteria, and 1985 WHO criteria. World Health Organization. Diabetes Res Clin Pract, 1999, 44(1):21-26.
12.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
13.	Arnolds S, Dellweg S, Clair J, et al. Further improvement in postprandial glucose control with addition of exenatide or sitagliptin to combination therapy with insulin glargine and metformin. Diabetes Care, 2010, 33:1509-1515.
14.	Bergenstal RM, Wysham C, Macconell L, et al. Efficacy and safety of exenatide once weekly versus sitagliptin or pioglitazone as an adjunct to metformin for treatment of type 2 diabetes (DURATION-2):a randomized trial. Lancet, 2010, 376:431-439.
15.	Pratley RE, Nauck M, Bailey T, et al. Liraglutide versus sitagliptin for patients with type 2 diabetes who did not have adequate glycaemic control with metformin:a 26-week, randomised, parallel-group, open-label trial. Lancet, 2010, 375:1447-1456.
16.	Russell-Jones D, Cuddihy RM, Hanefeld M, et al. Efficacy and safety of exenatide once weekly versus metformin, pioglitazone, and sitagliptin used as monotherapy in drug-na?ve patients with type 2 diabetes (DURATION-4). Diabetes Care, 2012, 35:252-258.
17.	Pratley RE. Overview of glucagon-like peptide-1 analogs and dipeptidyl peptidase-4 inhibitors for type 2 diabetes. Medscape J Med, 2008, 10(7):171.
18.	Amori RE, Lau J, Pittas AG. Efficacy and safety of incretin therapy in type 2 diabetes:systematic review and meta-analysis. JAMA, 2007, 298(2):194-206.
19.	Barnett A, Allsworth J, Jameson K, et al. A review of the effects of antihyperglycaemic agents on body weight:The potential of incretin targeted therapies. Curr Med Res Opin, 2007, 23(7):1493-1507.
20.	唐松濤, 章秋, 王長江, 等. 2型糖尿病患者應用利拉魯肽的療效和安全性系統評價.中華糖尿病雜志, 2011, 3(6):449-456.
21.	Waugh N, Cummins E, Royle P, et al. Newer agents for blood glucose control in type 2 diabetes:Systematic review and economic evaluation. Health Technology Assessment, 2010, 14(36):3-247.
22.	Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010說明與詳述:報告平行對照隨機臨床試驗指南的更新.中西醫結合學報, 2010, 8(8):701-741.
23.	Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes:a consensus algorithm for the initiation and adjustment of therapy. Diabetes Care, 2009, 32(1):193-203.

1. Richard EP, Gilbert M. Targeting incretins in type 2 diabetes:role of GLP-1 receptor agonists and DPP-4 inhibitors. The Review of Diabetic Studies, 2008, 5(2):73-94.
2. 張立宏, 王莉莉, 李松.二肽基肽酶-Ⅳ抑制劑藥理學作用及機制的研究進展.中國新藥雜志.2009, 18(11):1000-1004.
3. 周映紅, 黃文龍, 張惠斌, 等. GLP-1受體激動劑及DPP-Ⅳ抑制劑的研究進展.中國藥科大學學報. 2008, 39(5):385-391.
4. 凌雪梅, 楊春霞.沙格列汀改善2型糖尿病患者β細胞功能的Meta分析.中國循證醫學雜志. 2013, 13(4):436-440.
5. 李吉, 孫家忠, 李廣森, 等.西格列汀聯合二甲雙胍治療2型糖尿病效果的系統評價.中國循證醫學雜志. 2013, 13(7):836-843.
6. 占美, 吳逢波, 黃晶, 等.維格列汀改善2型糖尿病患者B細胞功能的Meta分析.中國藥房, 2012, 23(6):555-557.
7. Aaboe K, Knop FK, Vilsb?ll T, et al. Twelve weeks treatment with the DPP-4 inhibitor, sitagliptin, prevents degradation of peptide YY and improves glucose and non-glucose induced insulin secretion in patients with type 2 diabetes mellitus. Diabetes Obes Metab, 2010, 12(4):323-333.
8. 顏新, 鄧宏明, 肖常青, 等.利拉魯肽治療2型糖尿病的系統評價.循證醫學, 2012, 12(2):117-124.
9. Fakhoury WK, Lereun C, Wright D. A meta-analysis of placebo-controlled clinical trials assessing the efficacy and safety of incretin-based medications in patients with type 2 diabetes. Pharmacology, 2010, 86(1):44-57.
10. 占美, 吳逢波, 吳斌, 等.沙格列汀治療糖尿病安全性的系統評價.中國醫院藥學雜志, 2012, 32(12):940-943.
11. Puavilai G, Chanprasertyotin S, Sriphrapradaeng A. Diagnostic criteria for diabetes mellitus and other categories of glucose intolerance:1997 criteria by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (ADA), 1998 WHO consultation criteria, and 1985 WHO criteria. World Health Organization. Diabetes Res Clin Pract, 1999, 44(1):21-26.
12. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
13. Arnolds S, Dellweg S, Clair J, et al. Further improvement in postprandial glucose control with addition of exenatide or sitagliptin to combination therapy with insulin glargine and metformin. Diabetes Care, 2010, 33:1509-1515.
14. Bergenstal RM, Wysham C, Macconell L, et al. Efficacy and safety of exenatide once weekly versus sitagliptin or pioglitazone as an adjunct to metformin for treatment of type 2 diabetes (DURATION-2):a randomized trial. Lancet, 2010, 376:431-439.
15. Pratley RE, Nauck M, Bailey T, et al. Liraglutide versus sitagliptin for patients with type 2 diabetes who did not have adequate glycaemic control with metformin:a 26-week, randomised, parallel-group, open-label trial. Lancet, 2010, 375:1447-1456.
16. Russell-Jones D, Cuddihy RM, Hanefeld M, et al. Efficacy and safety of exenatide once weekly versus metformin, pioglitazone, and sitagliptin used as monotherapy in drug-na?ve patients with type 2 diabetes (DURATION-4). Diabetes Care, 2012, 35:252-258.
17. Pratley RE. Overview of glucagon-like peptide-1 analogs and dipeptidyl peptidase-4 inhibitors for type 2 diabetes. Medscape J Med, 2008, 10(7):171.
18. Amori RE, Lau J, Pittas AG. Efficacy and safety of incretin therapy in type 2 diabetes:systematic review and meta-analysis. JAMA, 2007, 298(2):194-206.
19. Barnett A, Allsworth J, Jameson K, et al. A review of the effects of antihyperglycaemic agents on body weight:The potential of incretin targeted therapies. Curr Med Res Opin, 2007, 23(7):1493-1507.
20. 唐松濤, 章秋, 王長江, 等. 2型糖尿病患者應用利拉魯肽的療效和安全性系統評價.中華糖尿病雜志, 2011, 3(6):449-456.
21. Waugh N, Cummins E, Royle P, et al. Newer agents for blood glucose control in type 2 diabetes:Systematic review and economic evaluation. Health Technology Assessment, 2010, 14(36):3-247.
22. Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010說明與詳述:報告平行對照隨機臨床試驗指南的更新.中西醫結合學報, 2010, 8(8):701-741.
23. Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes:a consensus algorithm for the initiation and adjustment of therapy. Diabetes Care, 2009, 32(1):193-203.

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Chinese Journal of Evidence-Based Medicine

Effects of GLP-1 Receptor Agonists versus DPP-4 Inhibitors for Type 2 Diabetes Mellitus: A Systematic Review

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