The efficacy and safety of DPP4 inhibitors in patients with type 1 diabetes: A systematic review and meta-analysis

Aims: Dipeptidyl peptidase-4 (DPP4) inhibitors are a novel class of antidiabetic medication in the treatment of type 2 diabetes mellitus. Several studies have indicated that DPP4 inhibitors could be used for type 1diabetes (T1DM). Here, we performed a meta-analysis to assess the efficacy and safety of DPP4 inhibitor therapy in patients with T1DM. Methods: We conducted searches on Medline, Cochrane Library, Web of Science, and EMBASE for relevant studies published before November 21, 2015. Mean difference (MD) with 95% confidence interval (CI) was calculated for the mean glycated hemoglobin (HbA1c) changes and insulin dosage from baseline to endpoint. Risk ratio (RR) with 95% CI was calculated for severe hypoglycemia. Data was extracted by two independent reviewers, and the meta-analysis was performed using Review Manager version 5.3. Results: Six randomized controlled trials with a total of 228 individuals were finally included into the meta-analysis. DPP4 inhibitors reduced daily insulin dosage significantly (MD -2.41 U/day, 95% CI [-3.87, -0.94], P = 0.001) but did not reduce HbA1c level (MD 0.0% (0 mmol/mol), 95% CI [-0.16, 0.15], P = 0.97). Furthermore, DPP4 inhibitors did not change the incidence of severe hypoglycemia (RR 0.81, 95% CI [0.34, 1.93], P = 0.64). Conclusion: In patients with T1DM, DPP4 inhibitors combined with insulin do not increase or decrease the risk of hypoglycemia and do not decrease HbA1c levels. (C) 2016 Elsevier Ireland Ltd. All rights reserved.