Susan Tran1, Ravi Retnakaran1,2,3, Bernard Zinman1,2,3, Caroline K Kramer1,2. 1. Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada. 2. Division of Endocrinology, University of Toronto, Toronto, Canada. 3. Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.
Abstract
AIMS: Glucagon-like peptide-1 (GLP-1) agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors are both incretin-based therapies for type 2 diabetes (T2DM) but have distinct efficacy and side effect profiles. We thus performed a systematic review and meta-analysis to compare the effects of GLP-1 agonists to DPP-4 inhibitors on glycaemic control, weight and incidence of adverse events in adults with T2DM. We also sought to determine whether there was any additional effect in switching from DPP-4 inhibitor to GLP-1 agonist. MATERIALS AND METHODS: We systematically searched PubMed, Embase and ClinicalTrials.gov for (1) randomized controlled trials (RCTs) comparing any GLP-1 agonist to any DPP-4 inhibitor and (2) interventional studies where a DPP-4 inhibitor was switched to a GLP-1 agonist. We assessed pooled data using random-effects model (CRD42017057115). RESULTS: The pooled analysis of 13 RCTs (n = 4330) showed that, compared to DPP-4 inhibitors, GLP-1 agonists yielded a greater mean reduction in glycated haemoglobin (HbA1c) of -0.41% (95% CI -0.53 to -0.30) and in weight of -2.15 kg (-3.04 to -1.27). GLP-1 agonists were associated with greater likelihood of gastrointestinal side effects with no increased risk of hypoglycaemia. In 5 interventional studies (n = 433), switching from DPP-4 inhibitor to GLP-1 agonist yielded further mean reduction in HbA1c of -0.69% (-1.03 to -0.35) and in weight of -2.25 kg (-3.12 to -1.38). CONCLUSIONS: GLP-1 agonists yield greater reduction in HbA1c and weight as compared to DPP-4 inhibitors, with increased incidence of gastrointestinal symptoms but not hypoglycaemia. Replacing a DPP-4 inhibitor with GLP-1 agonist provides additional benefits in glycaemic control and weight loss.
AIMS: Glucagon-like peptide-1 (GLP-1) agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors are both incretin-based therapies for type 2 diabetes (T2DM) but have distinct efficacy and side effect profiles. We thus performed a systematic review and meta-analysis to compare the effects of GLP-1 agonists to DPP-4 inhibitors on glycaemic control, weight and incidence of adverse events in adults with T2DM. We also sought to determine whether there was any additional effect in switching from DPP-4 inhibitor to GLP-1 agonist. MATERIALS AND METHODS: We systematically searched PubMed, Embase and ClinicalTrials.gov for (1) randomized controlled trials (RCTs) comparing any GLP-1 agonist to any DPP-4 inhibitor and (2) interventional studies where a DPP-4 inhibitor was switched to a GLP-1 agonist. We assessed pooled data using random-effects model (CRD42017057115). RESULTS: The pooled analysis of 13 RCTs (n = 4330) showed that, compared to DPP-4 inhibitors, GLP-1 agonists yielded a greater mean reduction in glycated haemoglobin (HbA1c) of -0.41% (95% CI -0.53 to -0.30) and in weight of -2.15 kg (-3.04 to -1.27). GLP-1 agonists were associated with greater likelihood of gastrointestinal side effects with no increased risk of hypoglycaemia. In 5 interventional studies (n = 433), switching from DPP-4 inhibitor to GLP-1 agonist yielded further mean reduction in HbA1c of -0.69% (-1.03 to -0.35) and in weight of -2.25 kg (-3.12 to -1.38). CONCLUSIONS:GLP-1 agonists yield greater reduction in HbA1c and weight as compared to DPP-4 inhibitors, with increased incidence of gastrointestinal symptoms but not hypoglycaemia. Replacing a DPP-4 inhibitor with GLP-1 agonist provides additional benefits in glycaemic control and weight loss.
Authors: Julio Rosenstock; Dale Allison; Andreas L Birkenfeld; Thalia Marie Blicher; Srikanth Deenadayalan; Jacob Bonde Jacobsen; Pierre Serusclat; Rafael Violante; Hirotaka Watada; Melanie Davies Journal: JAMA Date: 2019-04-16 Impact factor: 56.272
Authors: Richard E Pratley; Matthew J Crowley; Mette Gislum; Christin L Hertz; Thomas B Jensen; Kamlesh Khunti; Ofri Mosenzon; John B Buse Journal: Diabetes Ther Date: 2021-03-04 Impact factor: 2.945
Authors: Henrik H Hansen; Rikke V Grønlund; Tamara Baader-Pagler; Peter Haebel; Harald Tammen; Leif Kongskov Larsen; Jacob Jelsing; Niels Vrang; Thomas Klein Journal: Sci Rep Date: 2021-04-13 Impact factor: 4.379
Authors: Ashok K Das; Pramod Gandhi; Banshi Saboo; Sanjay Reddy; Rajeev Chawla; Abdul Hamid Zargar; Rajiv Kovil; Manoj Chawla; S K Sharma; Sunil Gupta; B M Makkar; Vinod Mittal; Soumik Goswami; S R Arvind; Shalini Jaggi; Sarita Bajaj; Sambit Das Journal: J Family Med Prim Care Date: 2021-12-27