| Part 1 Head-to-head comparison of the efficacy, safety and gastrointestinal hormone between DPP-4 inhibitors and a-glucosidase inhibitors in type 2 diabetes mellitus: A Meta-analysisObjectives:To assess the efficacy, safety and the effects on gastrointestinal hormone of DPP-4 inhibitors and a-glucosidase inhibitors in type 2 diabetes mellitus.Methods:The Cochrane Library, EMbase, PubMed, CBM, VIP and WanFang were searched to collect the randomized controlled trials(RCTs)on DPP-4 inhibitors versus a-glucosidase inhibitors in treatment of type 2 diabetes from inception to July 2015. By the two researchers according to the inclusion and exclusion criteria screening test, data were extracted according to the quality evaluation of the evaluation system of Cochrane Handbook. Meta analysis was carried out using RevMan 5.3 software.Results:A total of 18 RCTs were included in the study. Meta analysis showed that the DPP-4 inhibitors given as monotherapy or combination therapy led to greater reduction in HbAlc levels [MD=-0.29,95%CI (-0.48,-0.10); MD=-0.23,95%CI (-0.36,-0.1)],fasting plasma glucose levels[MD=-0.48,95%CI (-0.94,-0.03); MD=-0.25,95%CI(-0.47,-0.03)] and significantly greater change from baseline in the 2 hours postprandial blood glucose levels [MD=-0.77,95%CI(-1.42,-0.12)]. DPP-4 inhibitors significantly improved HOMA-B [MD=9.22,95%CI(5.61,12.84)] but improvement in HOMA-IR was comparable between DPP-4 inhibitors and a-glucosidase inhibitors[MD= 0.13,95%CI(-0.17,0.44)].Compared with DPP-4 inhibitors, treatment with a-glucosidase inhibitors was associated with a significantly greater decrease in the weight change from baseline[MD=0.72,95%CI (0.51,0.94); MD=1.30,95%CI (1.28,1.32)]. DPP-4 inhibitors were associated with a significantly greater decrease in the total cholesterol level and low-density lipoprotein cholesterol level [MD=-0.20,95%CI(-0.20,-0.20); MD=-0.17,95%CI(-0.27,-0.07)]. Compared with a-glucosidase inhibitors, treatment with DPP-4 inhibitors was associated with a significantly lower incidence of total adverse events[OR=0.49, 95%CI(0.36,0.66)], but there was no statistical difference in the incidence of cardiovascular events and hypoglycemic [OR=1.83,95%CI(0.92,3.66); OR= 0.97, 95%CI(0.46,2.07)]. DPP-4 inhibitors lead to significantly greater reduction in fasting and 2 hours postprandial ghrelin levels[MD=-135.43,95%CI(-166.66,-104.20); MD=-58.16,95%CI(-88.81,-27.51)]; DPP-4 inhibitors lead to significantly greater reduction in 2 hours postprandial gastrin level[MD=-7.95,95%C1(-13.35,-2.55)], but there was no statistical difference in the fasting gastrin level [MD=-0.66, 95%CI(-6.75,5.43)].Conclusions:DPP-4 inhibitors is effective and safe in treatment of type 2 diabetes,but a-glucosidase inhibitors has more advantages on weight loss. Both of them have a effect on the level of gastrin, gastrin and glucagon-like peptide-1.It is still need more long-term study in large scale with high quality to confirm long-term outcomes and its effects on gastrointestinal hormones.Part 2 Efficacy and safety of linagliptin in treatment of type 2 diabetes mellitus:A Meta-analysisObjectives:To assess the efficacy and safety of linagliptin in treatment of type 2 diabetes.Methods:The Cochrane Library, EMbase, PubMed, CNKI, CBM, VIP and WanFang were searched to collect the randomized controlled trials(RCTs)on linagliptin versus placebo in treatment of type 2 diabetes from inception to January 2015. By the two researchers according to the inclusion and exclusion criteria screening test, data were extracted according to the quality evaluation of the evaluation system of Cochrane Handbook, Meta analysis was carried out using RevMan 5.3 software.Results:A total of 16 RCTs were included in the study.Meta analysis showed that the linagliptin given as monotherapy led to greater reduction in HbAlc and FPG[MD=-0.76,95%CI(-0.85,-0.66); MD=-1.12,95%CI(-1.28,-0.95)],but there was no statistical difference in the incidence of overall adverse events and hypoglycemic[OR=0.86,95%CI(0.70,1.06); OR= 1.19,95%CI(0.36,4.01)].When linagliptin was combined with other oral antihyperglycemic drugs,it also led to greater reduction in HbAlc and FPG[MD=-0.61,95%CI(-0.67,-0.56); MD=-0.79, 95%CI(-0.96,-0.63)], and there was no statistical difference in the incidence of overall adverse events[OR=1.07,95%CI(0.92,1.24)],but it was inferior to the placebo in the incidence of hypoglycaemic[OR=1.55,95%CI(1.19,2.02)].Conclusions:Linagliptin is effective and safe in treatment of type 2 diabetes,but it is still need more long-term study in large scale with high quality to confirm long-term outcomes. |
PDF Full Text Request