Li Zhaoliang, Zhao Liang, Yu Leilei, Yang Jie
Department of Endocrinology, the Central Hospital of Tai'an City, Tai'an, China.
Front Pharmacol. 2019 Jul 10;10:777. doi: 10.3389/fphar.2019.00777. eCollection 2019.
The α-glucosidase inhibitors (AGIs) are commonly prescribed in Asian patients with type 2 diabetes mellitus (T2DM), but with a high incidence of gastrointestinal side effects. This study was aimed to compare the efficacy and safety of dipeptidyl peptidase-4 (DPP4) inhibitors and AGIs in T2DM patients in a meta-analysis. Randomized controlled trials were identified systematic search of PubMed, Embase, and Cochrane's Library databases from inception to February, 2019. Meta-analyses were performed a random or a fixed effect model according to the heterogeneity. Eighteen studies with a total of 4,051 patients with T2DM were included. The DPP4 inhibitors were associated with lower reduction of glycosylated hemoglobin (HbA1c) as compared with AGIs [weighed mean difference (WMD): -0.37%, < 0.001]. Subgroup analyses indicated that the benefit of DPP4 inhibitors as compared with AGIs on HbA1c were independent of study design, scale, baseline HbA1c, with or without concurrent medications, or follow-up durations. Moreover, compared to AGIs, DPP4 inhibitors was associated with lower reductions of fasting blood glucose (WMD: -0.53 mmol/L, < 0.001) and postprandial glucose at 2h (WMD: -0.60 mmol/L, = 0.04), moderately increased body weight (WMD: 0.34 kg, = 0.02), and decreased risk of gastrointestinal adverse events [risk ratio (RR): 0.48, < 0.001], but unaffected risk of symptomatic hypoglycemia (RR: 0.96, = 0.90). The DPP4 inhibitors are superior to AGIs in T2DM patients for better glycemic control and lower risks of gastrointestinal side effects.
α-葡萄糖苷酶抑制剂（AGIs）常用于亚洲2型糖尿病（T2DM）患者，但胃肠道副作用发生率较高。本研究旨在通过荟萃分析比较二肽基肽酶-4（DPP4）抑制剂和AGIs在T2DM患者中的疗效和安全性。通过对PubMed、Embase和Cochrane图书馆数据库从创建到2019年2月进行系统检索，确定随机对照试验。根据异质性，采用随机或固定效应模型进行荟萃分析。纳入了18项研究，共4051例T2DM患者。与AGIs相比，DPP4抑制剂与糖化血红蛋白（HbA1c）降低幅度较小相关[加权平均差（WMD）：-0.37%，P<0.001]。亚组分析表明，与AGIs相比，DPP4抑制剂对HbA1c的益处与研究设计、规模、基线HbA1c、是否同时使用药物或随访时间无关。此外，与AGIs相比，DPP4抑制剂与空腹血糖降低幅度较小（WMD：-0.53 mmol/L，P<0.001）和餐后2小时血糖降低幅度较小（WMD：-0.60 mmol/L，P=0.04）、体重适度增加（WMD：0.34 kg，P=0.02）以及胃肠道不良事件风险降低（风险比（RR）：0.48，P<0.001）相关，但对有症状低血糖风险无影响（RR：0.96，P=0.90）。在T2DM患者中，DPP4抑制剂在血糖控制和胃肠道副作用风险较低方面优于AGIs。
