title: Effects on lipid profile of dipeptidyl peptidase 4 inhibitors, pioglitazone, acarbose, and sulfonylureas: meta-analysis of placebo-controlled trials.
abstract: BACKGROUND
  Lipid profile is an important determinant of cardiovascular risk in type 2 diabetes. It is well known that patients with type 2 diabetes are more likely to be dyslipidemic than the general population. Given the observed connection between glucose and lipid metabolism in patients with type 2 diabetes, it is conceivable that different glucose-lowering agents can have a varying impact on the lipid profile. When metformin monotherapy fails, other drugs can be added to achieve sufficient glycemic control. Available oral agents include pioglitazone, acarbose, dipeptidyl peptidase 4 (DPP-4) inhibitors, and insulin secretagogs. The present meta-analysis was designed to assess the effect of DPP-4 inhibitors, pioglitazone, insulin secretagogs, and acarbose on blood lipids when compared to placebo.
  
  
  METHODS
  An extensive search (any date up to November 1, 2011) was performed for all trials performed on the following classes of drugs: gliptin, insulin secretagogs, pioglitazone, and acarbose. The following endpoints were considered: endpoint total, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) and triglycerides.
  
  
  RESULTS
  The difference in mean total cholesterol values at endpoint versus baseline was significantly higher in patients on pioglitazone, sulfonylureas, and DPP-4 inhibitor treatment (but not on acarbose) than those on placebo, demonstrating that treatment with these drugs (except acarbose) is associated with a significant reduction in total cholesterol. With respect to triglycerides, a significant reduction could be observed with acarbose, pioglitazone, and DPP-4 inhibitors, but not with sulfonylureas. HDL-C appeared to be increased by treatment with acarbose and pioglitazone, and decreased by sulfonylureas.
  
  
  CONCLUSIONS
  The present meta-analysis shows that available glucose-lowering drugs may have varying effects on the lipid profile. DPP-4 inhibitors, acarbose, and pioglitazone seem to have a more favorable effect on the lipid profile than sulfonylureas.
authors.affiliation: Geriatric Cardiology, Azienda Ospedaliero-Universitaria Careggi, Careggi Teaching Hospital and University of Florence, Via delle Oblate 4, Florence, Italy. mmonami@libero.it
authors.forename: Matteo
authors.initials: M
authors.lastname: Monami
authors.forename: Valentina
authors.initials: V
authors.lastname: Vitale
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Ambrosio
authors.forename: Nadia
authors.initials: N
authors.lastname: Bartoli
authors.forename: Giulia
authors.initials: G
authors.lastname: Toffanello
authors.forename: Benedetta
authors.initials: B
authors.lastname: Ragghianti
authors.forename: Francesca
authors.initials: F
authors.lastname: Monami
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
mesh_terms: D020909:Acarbose / Q000627:therapeutic use; D008076:Cholesterol, HDL / Q000187:drug effects; D008078:Cholesterol, LDL / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000077205:Pioglitazone; D016032:Randomized Controlled Trials as Topic; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D045162:Thiazolidinediones / Q000627:therapeutic use; D014280:Triglycerides / Q000097:blood
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D014280:Triglycerides; D020909:Acarbose; D000077205:Pioglitazone