Chen Maosheng, Liu Yueming, Jin Juan, He Qiang
a Department of Nephrology , Zhejiang Provincial People's Hospital , Hangzhou , PR China ;
b National Clinical Research Center of Kidney Diseases , Jinling Hospital, Nanjing University School of Medicine , Nanjing , PR China ;
Ren Fail. 2016;38(4):581-7. doi: 10.3109/0886022X.2016.1149682. Epub 2016 Feb 26.
AIMS/INTRODUCTION: Dipeptidyl peptidase-4 (DPP-4) inhibitors are a new class of oral antidiabetic agents, and have been increasingly and widely used in the treatment of diabetes mellitus (DM). However, information of DPP-4 inhibitors in type 2 DM patients with severe renal impairment (RI) is limited. Our study aimed to assess the efficacy and safety of DPP-4 inhibitors as compared to placebos or other hypoglycemic drugs in type 2 DM patients with severe RI.
A meta-analysis was conducted to examine the literature comparing the effects of DPP-4 inhibitors on hemoglobin A1c (HbA1c) and fasting blood glucose (FBG). Randomized control trials (RCTs) including adults with type 2 DM and severe RI were analyzed. Safety was evaluated based on the percentage of patients who developed hypoglycemia and the occurrence of adverse events (AEs) as well as the incidence of peripheral edema, urinary tract infection, diarrhea, and death.
Five RCTs including 503 patients were analyzed. Compared with a placebo or no treatment, DPP-4 inhibitors were associated with a larger decline in HbA1c (mean difference (MD) = -0.57, 95% confidence interval (CI): -0.73 to -0.41; p < 0.01) but not with FBG (MD = -0.26, 95% CI: -1.40 to 0.8; p = 0.66). Compared with glipizide monotherapy, no significant differences in HbA1c (MD = 0.15, 95% CI: -0.19 to 0.49; p = 0.38) or FBG (MD = -0.26, 95% CI: -1.16 to 0.64; p = 0.57) were found. Similar odds of experiencing an AE were found in both the DPP-4 inhibitor groups and comparison groups.
In type 2 DM patients with severe RI, treatment with DPP-4 inhibitors is safe and it effectively lowers HbA1c.
目的/引言：二肽基肽酶-4（DPP-4）抑制剂是一类新型口服抗糖尿病药物，已越来越广泛地用于治疗糖尿病（DM）。然而，关于DPP-4抑制剂在重度肾功能损害（RI）的2型糖尿病患者中的信息有限。我们的研究旨在评估与安慰剂或其他降糖药物相比，DPP-4抑制剂在重度RI的2型糖尿病患者中的疗效和安全性。
进行一项荟萃分析，以研究比较DPP-4抑制剂对糖化血红蛋白（HbA1c）和空腹血糖（FBG）影响的文献。分析纳入患有2型糖尿病和重度RI的成年人的随机对照试验（RCT）。根据发生低血糖的患者百分比、不良事件（AE）的发生情况以及外周水肿、尿路感染、腹泻和死亡的发生率评估安全性。
分析了包括503例患者的5项RCT。与安慰剂或未治疗相比，DPP-4抑制剂与HbA1c的更大降幅相关（平均差（MD）=-0.57，95%置信区间（CI）：-0.73至-0.41；p<0.01），但与FBG无关（MD=-0.26，95%CI：-1.40至0.8；p=0.66）。与格列吡嗪单药治疗相比，未发现HbA1c（MD=0.15，95%CI：-0.19至0.49；p=0.38）或FBG（MD=-0.26，95%CI：-1.16至0.64；p=0.57）有显著差异。在DPP-4抑制剂组和对照组中发生AE的几率相似。
在重度RI的2型糖尿病患者中，DPP-4抑制剂治疗是安全的，并且能有效降低HbA1c。
