Merck Research Laboratories (MRL) Global Medical Affairs, Merck Sharp & Dohme (MSD) China, Shanghai, China.
Hatter Cardiovascular Institute, University College London, UK and Ulster University, Coleraine, United Kingdom.
Front Endocrinol (Lausanne). 2022 Oct 12;13:994944. doi: 10.3389/fendo.2022.994944. eCollection 2022.
Hyperglucagonemia occurs in the pathogenesis of type 2 diabetes mellitus (T2DM). In this meta-analysis, we summarized the effects of DPP4 inhibitors on glucagon levels in patients with T2DM.
Randomized controlled trials (RCTs) comparing the influence of DPP4 inhibitors on circulating glucagon levels with placebo or other oral antidiabetic drugs (OADs) in patients with T2DM were identified by searches of Medline (PubMed), Embase (Ovid), and CENTER (Cochrane Library). Only studies reporting changes in glucagon level presented as total area under the curve (AUC) using a meal or oral glucose tolerance test were included. Results were combined using a random-effects model that incorporated potential heterogeneity among the included studies.
A total of 36 RCTs with moderate to high quality were included. Overall, the numbers of T2DM patients included for the meta-analyses comparing DPP4 inhibitors with placebo and other OADs were 4266 and 1652, respectively. Compared to placebo, DPP4 inhibitors significantly reduced circulating glucagon levels (standard mean difference [SMD]: -0.32, 95% CI: -0.40 to -0.24, <0.001; I 28%). Analysis of subgroups revealed that study characteristics had no significant effect on results, such as study design (parallel group or crossover), number of patients, mean patient age, proportion of men, baseline HbA1c, duration of diabetes, background therapy, treatment duration, or methods for glucagon measurement (all for subgroup differences >0.05). Moreover, DPP4 inhibitors significantly reduced glucagon levels compared to other OADs (SMD: -0.35, 95% CI: -0.53 to -0.16, <0.001; I = 66%), and the reduction in glucagon was greater in comparison with insulin secretagogues than in comparison with non-insulin secretagogues ( for subgroup difference =0.03).
https://inplasy.com/, identifier INPLASY202280104.
DPP4 inhibitors are effective at reducing the circulating postprandial glucagon level in T2DM patients.
高血糖素血症发生在 2 型糖尿病（T2DM）的发病机制中。在这项荟萃分析中，我们总结了 DPP4 抑制剂对 T2DM 患者胰高血糖素水平的影响。
通过检索 Medline（PubMed）、Embase（Ovid）和 CENTER（Cochrane 图书馆），确定了比较 DPP4 抑制剂对 T2DM 患者循环胰高血糖素水平影响的随机对照试验（RCT），与安慰剂或其他口服降糖药（OAD）相比。仅包括报告使用餐或口服葡萄糖耐量试验时胰高血糖素水平变化的研究，结果采用随机效应模型合并，该模型纳入了纳入研究之间的潜在异质性。
共纳入 36 项 RCT，质量为中等到高度。总体而言，用于比较 DPP4 抑制剂与安慰剂和其他 OAD 的 meta 分析中包括的 T2DM 患者人数分别为 4266 人和 1652 人。与安慰剂相比，DPP4 抑制剂显著降低循环胰高血糖素水平（标准均数差[SMD]：-0.32，95%CI：-0.40 至-0.24，<0.001；I 2 8%）。亚组分析显示，研究特征对结果没有显著影响，例如研究设计（平行组或交叉）、患者人数、患者平均年龄、男性比例、基线 HbA1c、糖尿病病程、背景治疗、治疗持续时间或胰高血糖素测量方法（所有亚组差异>0.05）。此外，与其他 OAD 相比，DPP4 抑制剂显著降低了胰高血糖素水平（SMD：-0.35，95%CI：-0.53 至-0.16，<0.001；I = 66%），与胰岛素分泌剂相比，与非胰岛素分泌剂相比，胰高血糖素的降低更为明显（亚组差异=0.03）。
https://inplasy.com/，标识符 INPLASY202280104。
DPP4 抑制剂可有效降低 T2DM 患者餐后循环胰高血糖素水平。
