ObjectiveTo systematically review the effectiveness and safety of GLP-1 receptor agonists versus DPP-4 inhibitors for type 2 diabetes mellitus (T2DM). MethodsDatabases 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. ResultsA 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). ConclusionGLP-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.
ObjectiveTo systematically evaluate the safety of dipeptidyl peptidase-4 (DPP-4) inhibitors on the risk of cardiovascular events in type 2 diabetes mellitus (T2DM) patients. MethodsDatabases such as the Cochrane Library, PubMed, Elsevier ScienceDirect and EMbase were searched to collect randomized controlled trials (RCTs) about DPP-4 inhibitors for T2DM patients from inception to February 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan5.2 software. ResultsA total of 20 RCTs involving 10 402 patients were included. The results of meta-analysis showed that:there were no significant differences between the DPP-4 inhibitors group and the control group in the cardiovascular adverse events (RR=0.86, 95%CI 0.62 to 1.20, P=0.38) and acute coronary syndrome (RR=0.66, 95%CI 0.37 to 1.17, P=0.15). Subgroup analyses by type of liptins and durations showed there were lower risks of adverse cardiovascular events in the DPP-4 inhibitors group of the sitagliptin subgroup (RR=0.49, 95%CI 0.29 to 0.82, P=0.007) and the duration of ≥52 weeks subgroup (RR=0.62, 95%CI 0.39 to 0.97, P=0.04). No significant difference was found between the two groups in hypertension events (RR=1.09, 95%CI 0.84 to 1.40, P=0.52). ConclusionThe DPP-4 inhibitors are relatively safe. In the long-term treatment of T2DM, the sitagliptin could not only effectively control the level of blood sugar but also might obtain benefits in cardiovascular aspects.