Evaluation Of The Effectiveness And Economics Of DPP-4 Inhibitors And GLP-1 Receptor Agonists In The Treatment Of Type 2 Diabetes

ObjectivesTo evaluate the effectiveness and safety of DPP-4 inhibitors and GLP-1 receptor agonists in the treatment of type 2 diabetes patients by Meta analysis from the patient's point of view,and the economics of DPP-4 inhibitors and GLP-1 receptor agonists in conjunction with the actual treatment costs.The balance between two drugs' effect and cost will provide reference for guiding clinical use of drugs,reducing medical expenses,improving the use of resources of drugs,and maximizing the output of health effects.MethodsThis study identifies the research problems,summarizes the previous research results and existing problems,retrieves literature for Meta analysis through literature research.The cost and benefits of DPP-4 inhibitors and GLP-1 receptor agonists in the treatment of type 2 diabetes were studied through the drug economic evaluation method based on the actual drug cost,and their respective advantages and disadvantages were analyzed to guide the use of medical resources.The objectivity and scientific will be ensured by expert consultation.ContentsTo evaluate the effectiveness of DPP-4 inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes,including glycosylated hemoglobin,fasting blood glucose,2 hour postprandial blood glucose,total cholesterol,triglyceride,high-density lipoprotein cholesterol and low-density lipoprotein cholesterol and so on.To evaluate the safety of DPP-4 inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes,including low blood sugar incidence and adverse effects incidence.To evaluate the cost-efficiency of DPP-4 inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes by using the actual cost of the hospital as cost data and combined with the results of the Meta analysis.ResultsThe results of the Meta analysis of this study for effectiveness indicators showed that in the overall analysis of glycosylated hemoglobin,fasting blood glucose,and 2 hour postprandial blood glucose:the clinical hypoglycemic effect of the GLP-1 receptor agonist group was better,and the results were statistically significant.Subgroup analysis due to heterogeneity has little effect on the results.Some subgroups show that there is no statistically significant difference between the two groups of GLP-1 receptor agonists and DPP-4 inhibitors.In the overall analysis of body quality:the clinical weight loss effect of GLP-1 receptor agonists was better,and the results were statistically significant.Subgroup analysis due to heterogeneity has no effect on the results.In the overall analysis of total cholesterol,triglyceride,and low-density lipoprotein cholesterol:the clinical lipid-lowering effect of the GLP-1 receptor agonist group was better,and the results were statistically significant.Subgroup analysis due to heterogeneity has little effect on the results.Some subgroups show that there is no statistically significant difference between the two groups of GLP-1 receptor agonists and DPP-4 inhibitors.In the overall analysis of high-density lipoprotein cholesterol:there was no difference in clinical efficacy between the GLP-1 receptor agonist group and the DPP-4 inhibitor group.Subgroup analysis due to heterogeneity has no effect on the results.The results of Meta analysis of the safety indicators in this study showed that the overall analysis of hypoglycemia,gastrointestinal adverse reactions,and skin adverse reactions:DPP-4 inhibitors are safer than GLP-1 receptor agonists,and the results are statistically significant.In the overall analysis of severe adverse reactions,head adverse reactions,infection adverse reactions,and pain adverse reactions,the difference between the DPP-4 inhibitors and the GLP-1 receptor agonists group is not statistically significant.In the overall analysis of nasopharynx adverse reactions,the safety of the GLP-1 receptor agonists was better,and the results were statistically significant.The results of the economic evaluation of this study showed that patients in Liraglutide group have to pay 1904.22 yuan more to reduce 1%HbAlc than Sitagliptin group,patients in Liraglutide group have to pay 2520.00 yuan more to reduce 1%HbA1c than Vildagliptin group,patients in Exenatide group have to pay 3567.93 yuan more to reduce 1%HbA1c than Alogliptin group,patients in Liraglutide+Metformin group have to pay 2951.41 yuan more to reduce 1%HbA1c than Saxagliptin + Metformin group,patients in Liraglutide +Metformin group have to pay 1472.08 yuan more to reduce 1%HbAlc than Sitagliptin +Metformin group,patients in Exenatide+Metformin group have to pay 11573.50 yuan more to reduce 1%HbA1c than Saxagliptin H+Metformin group,patients in Exenatide+Metformin group have to pay 2338.33 yuan more to reduce 1%HbA1c than Sitagliptin + Metformin group.Therefore,GLP-1 receptor agonists do not have significant economic benefits compared to DPP-4 inhibitors.ConclusionsGLP-1 receptor agonists perform no less than or even better than DPP-4 inhibitors on reducing blood sugar,reducing weight,and reducing blood lipids,but in terms of the safety,except for nasopharyngeal adverse reactions,other types of adverse reactions including hypoglycemia,DPP-4 inhibitors perform no less than or even better than GLP-1 receptor agonists.In addition,GLP-1 receptor agonists are less economical than DPP-4 inhibitors.GLP-1 receptor agonists have better clinical efficacy,but less secure and more expensive than DPP-4 inhibitors.Therefore,doctors should make appropriate choices according to the patient's physical condition and economic situation in clinical medication.