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.	张立宏, 王莉莉, 李松.二肽基肽酶-Ⅳ抑制剂药理学作用及机制的研究进展.中国新药杂志.2009, 18(11):1000-1004.
3.	周映红, 黄文龙, 张惠斌, 等. GLP-1受体激动剂及DPP-Ⅳ抑制剂的研究进展.中国药科大学学报. 2008, 39(5):385-391.
4.	凌雪梅, 杨春霞.沙格列汀改善2型糖尿病患者β细胞功能的Meta分析.中国循证医学杂志. 2013, 13(4):436-440.
5.	李吉, 孙家忠, 李广森, 等.西格列汀联合二甲双胍治疗2型糖尿病效果的系统评价.中国循证医学杂志. 2013, 13(7):836-843.
6.	占美, 吴逢波, 黄晶, 等.维格列汀改善2型糖尿病患者B细胞功能的Meta分析.中国药房, 2012, 23(6):555-557.
7.	Aaboe K, Knop FK, Vilsbøll 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.	颜新, 邓宏明, 肖常青, 等.利拉鲁肽治疗2型糖尿病的系统评价.循证医学, 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, 吴逢波, 吴斌, 等.沙格列汀治疗糖尿病安全性的系统评价.中国医院药学杂志, 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-naïve 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.	唐松涛, 章秋, 王长江, 等. 2型糖尿病患者应用利拉鲁肽的疗效和安全性系统评价.中华糖尿病杂志, 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说明与详述:报告平行对照随机临床试验指南的更新.中西医结合学报, 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. 张立宏, 王莉莉, 李松.二肽基肽酶-Ⅳ抑制剂药理学作用及机制的研究进展.中国新药杂志.2009, 18(11):1000-1004.
3. 周映红, 黄文龙, 张惠斌, 等. GLP-1受体激动剂及DPP-Ⅳ抑制剂的研究进展.中国药科大学学报. 2008, 39(5):385-391.
4. 凌雪梅, 杨春霞.沙格列汀改善2型糖尿病患者β细胞功能的Meta分析.中国循证医学杂志. 2013, 13(4):436-440.
5. 李吉, 孙家忠, 李广森, 等.西格列汀联合二甲双胍治疗2型糖尿病效果的系统评价.中国循证医学杂志. 2013, 13(7):836-843.
6. 占美, 吴逢波, 黄晶, 等.维格列汀改善2型糖尿病患者B细胞功能的Meta分析.中国药房, 2012, 23(6):555-557.
7. Aaboe K, Knop FK, Vilsbøll 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. 颜新, 邓宏明, 肖常青, 等.利拉鲁肽治疗2型糖尿病的系统评价.循证医学, 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, 吴逢波, 吴斌, 等.沙格列汀治疗糖尿病安全性的系统评价.中国医院药学杂志, 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-naïve 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. 唐松涛, 章秋, 王长江, 等. 2型糖尿病患者应用利拉鲁肽的疗效和安全性系统评价.中华糖尿病杂志, 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说明与详述:报告平行对照随机临床试验指南的更新.中西医结合学报, 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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Effects of GLP-1 Receptor Agonists versus DPP-4 Inhibitors for Type 2 Diabetes Mellitus: A Systematic Review

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