Dipeptidyl-peptidase IV inhibitors for treatment of type 2 diabetes mellitus:an overview of systematic reviews

Objective To evaluate the efficacy and safety of dipeptidyl-peptidase Ⅳ(DPP-4)inhibitors for treatment of type 2 diabetes mellitus.Methods The Cochrane Library,PubMed,Embase,Science Citation Index,the Chinese Journal Full-text Database,Chinese Scientific and Technical Periodicals Database,Chinese Biomedical Literature Database,and Wanfang Database were searched from the inception to August 2013.The key words were sitagliptin,vildagliptin,saxagliptin,linagliptin,alogliptin,dipeptidylpeptidase Ⅳ,systematic reviews,and meta-analysis.According to the inclusion and exclusion criteria,articles for systematic reviews and meta-analysis were selected.Their methodological qualities were evaluated using QQAQ scale and the data were analyzed using descriptive analysis.The main outcomes included the changes in hemoglobin Ale(HbAlc) and homeostasis model assessment of p-cell index(HOMA-p) and incidence of adverse events.Results A total of 18 articles were entered in this study.Of them,scores of methodological quality in 89 percent of articles(16 articles) were 6.0-7.0.The effects of DPP-4 inhibitors on HbAlc levels in patients with type 2 diabetes mellitus were evaluated in thirteen articles.The effects of sitagliptin,vildagliptin,saxagliptin,and linagliptin on HbAlc reduction were better than those of the placeboes,but the conclusions were controversial with other oral hypoglycemic drugs.The effects of DPP-4inhibitors on HOMA-p levels in patients with type 2 diabetes mellitus were evaluated in five articles.Sitagliptin,vildagliptin,and saxagliptin could significantly improve HOMA-β levels compared with the placeboes.The effect of sitagliptin on HOMA-β level improvement was not better than other oral antidiabetic drugs.The incidences of adverse events during the DPP-4 treatments were evaluated in 14 articles.The differences in the incidences of adverse events and hypoglycemia between the treatments with sitagliptin,vildagliptin,saxagliptin,linagliptin and the placeboes were not statistically significant.The incidences of hypoglycemia in treatment with sitagliptin and vidagliptin were lower than those with other oral hypoglycemic drugs.Conclusion DPP-4 inhibitors could control effectively the blood glucose in patients with type 2diabetes mellitus and the short-term safety was good.