title: Head-to-head comparison of dipeptidyl peptidase-IV inhibitors and sulfonylureas - a meta-analysis from randomized clinical trials.
abstract: BACKGROUND
  Dipeptidyl peptidase-IV (DPP-4) inhibitors and sulfonylureas are two important second-line anti-diabetic agents. The objective of this research was to evaluate the efficacy and safety of DPP-4 inhibitors compared with sulfonylureas by meta-analytic approach of available randomized studies.
  
  
  METHODS
  We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases up to 30 June 2013, collecting all randomized clinical trials with a treatment duration of ≥18weeks. Data on glycated haemoglobin (HbA1c ), body weight, hypoglycaemia, total adverse events, and cardiovascular events were retrieved and analysed.
  
  
  RESULTS
  The analysis included 12 randomized studies comprising 10 982 patients with type 2 diabetes mellitus. On the basis of meta-analysis, sulfonylureas lowered HbA1c significantly more than DPP-4 inhibitors with weighted mean difference (WMD) of 0.105 [95% confidence interval (CI) 0.103 to 0.107]. The results were consistent in trials with longer (>32 weeks) or shorter (≤32 weeks) duration; however, DPP-4 inhibitors showed greater reduction in HbA1c compared with the second-generation sulfonylureas and in patients with baseline eGFR < 50 mL/min/1.73 m(2) . Patients treated with DPP-4 inhibitors are less likely to achieve HbA1c  < 7% compared with sulfonylureas [Mantel-Haenszel odds ratio (MH-OR) 0.91; 95% CI 0.84 to 0.99]. DPP-4 xinhibitors were associated with a reduction in body weight (WMD -1.652; 95% CI -1.658 to -1.646) and lower risk of hypoglycaemia (MH-OR, 0.13; 95% CI 0.11 to 0.16), total adverse events (MH-OR, 0.79; 95% CI 0.72 to 0.87), and cardiovascular events (MH-OR, 0.53; 95% CI 0.32 to 0.87) compared with sulfonylureas.
  
  
  CONCLUSIONS
  Although DPP-4 inhibitors are less efficacious compared with sulfonylureas, they demonstrate a beneficial effect on body weight, episodes of hypoglycaemia, and total adverse events.
authors.affiliation: State Key Laboratory of Medical Genomics, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrinology and Metabolism, Endocrine and Metabolic E-Institutes of Shanghai Universities (EISU)and Key Laboratory for Endocrinology and Metabolism of Chinese Health Ministry, Rui-jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
authors.forename: Yifei
authors.initials: Y
authors.lastname: Zhang
authors.forename: Jie
authors.initials: J
authors.lastname: Hong
authors.forename: Jie
authors.initials: J
authors.lastname: Chi
authors.forename: Weiqiong
authors.initials: W
authors.lastname: Gu
authors.forename: Guang
authors.initials: G
authors.lastname: Ning
authors.forename: Weiqing
authors.initials: W
authors.lastname: Wang
mesh_terms: D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds
keywords: body weight; dipeptidyl peptidase-IV; efficacy; hypoglycaemia; safety; sulfonylureas; type 2 diabetes