title: The efficacy and safety of DPP4 inhibitors in patients with type 1 diabetes: A systematic review and meta-analysis.
abstract: OBJECTIVE
  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 -2.41U/day, 95% CI [-3.87, -0.94], P=0.001) but did not reduce HbA1c level (MD 0.0% (0mmol/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).
  
  
  CONCLUSIONS
  In patients with T1DM, DPP4 inhibitors combined with insulin do not increase or decrease the risk of hypoglycemia and do not decrease HbA1c levels.
authors.affiliation: Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China.
authors.forename: Heming
authors.initials: H
authors.lastname: Guo
authors.affiliation: Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Fang
authors.affiliation: Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Medical College, Soochow University, Suzhou 215003, Jiangsu, China.
authors.forename: Yufang
authors.initials: Y
authors.lastname: Pei
authors.affiliation: Department of Endocrinology, Children's Hospital of Soochow University, Suzhou 215000, Jiangsu, China.
authors.forename: Linqi
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China. Electronic address: huji@suda.edu.cn.
authors.forename: Ji
authors.initials: J
authors.lastname: Hu
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
keywords: DPP4 inhibitors; Meta-analysis; Type 1 diabetes