Efficacy And Safety Of GLP-1 Receptor Agonists Versus DPP-4 Inhibitors In The Treatment Of Type 2 Diabetes Mellitus:A Meta-analysis

Objective: To systematically evaluate the efficacy and safety of glucagon-like peptide-1(GLP-1)receptor agonists versus dipeptidyl peptidase-4(DPP-4)inhibitors in the treatment of type 2 diabetes mellitus,and to provide evidence-based reference for clinic.Methods: Pub Med,EMBASE,The Cochrane Library,Web of science,China Journal full-text Database(CNKI),China Biomedical Literature Database(CBM),Wanfang Database and VIP Information Resource system(VIP),were searched electronically for randomized controlled trials(RCTs)of the efficacy and safety of GLP-1 receptor agonists versus DPP-4 inhibitors in the treatment of type 2 diabetes mellitus.The retrieval period is from database establishment to December 2019.After the retrieval,two researchers independently screened the literatures according to the inclusion criteria and exclusion criteria,extracted the data of the included literatures,and evaluated the quality of the articles.Then the Review Manager 5.3 software was used for Meta-analysis.Results: 1.GLP-1 receptor agonist was more effective than DPP-4 inhibitor in reducing the levels of glycosylated hemoglobin(Hb A1c),and the difference was statistically significant[MD=-0.57,95%CI(-0.72,-0.42),P<0.00001].2.GLP-1 receptor agonist was more effective than DPP-4 inhibitor in reducing the levels of fasting blood glucose(FBG),and the difference was statistically significant[MD=-0.86,95%CI(-1.17,-0.56),P<0.00001].3.GLP-1 receptor agonist was more effective than DPP-4 inhibitor in reducing the levels of 2-h postprandial blood glucose(PBG),and the difference was statistically significant.4.GLP-1 receptor agonist was more effective than DPP-4 inhibitor in reducing the levels of body mass index(BMI),and the difference was statistically significant[MD=-1.86,95%CI(-2.46,-1.27),P<0.00001].5.There was no significant difference between GLP-1 receptor agonists and DPP-4 inhibitors in the occurrence of hypoglycemia [OR=0.99,95%CI(0.61,1.60),P=1.60].6.GLP-1 receptor agonist is more likely to cause gastrointestinal side effects than DPP-4 inhibitor,and the difference is statistically significant[OR=3.27,95%CI(2.43,4.38),P<0.00001].Conclusions: GLP-1 receptor agonists were more effective in reducing the levels of glycosylated hemoglobin,fasting blood glucose,2-hour postprandial blood glucose and body mass index,while DPP-4 inhibitors were better tolerated.