Dipeptidyl peptidase-4 (DPP-4) inhibitors and hypoglycaemia risk in patients with type 2 diabetes mellitus (T2DM): a network meta-analysis




Poster session 4


Tuesday 25 October 2016 - 15:30 to 16:00


All authors in correct order:

Cai T1, Wu S2, Xu Y1, Yang J1, Zhan S1, Sun F1
1 Department of Epidemiology and Biostatistics, School of Public Health, Peking University, China
2 National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, China
Presenting author and contact person

Presenting author:

Ting Cai

Contact person:

Abstract text
Objective: To systematically evaluate the effect of DPP-4 inhibitors on hypoglycaemia risk in patients with T2DM.

Methods: We searched MEDLINE, Embase, the Cochrane Library and ClinicalTrials.gov to 20 November 2015. We identified and reviewed randomized controlled trials (RCTs) assessing the safety of DPP-4 inhibitors versus placebo or other anti-diabetic drugs in T2DM patients. We estimated odds ratios (OR) with 95% confidence intervals (CI) for hypoglycaemia through network meta-analysis.

Results: We included 130 RCTs with 17 treatments: nine DPP-4 inhibitors (alogliptin, anagliptin, dutogliptin, gosogliptin, linagliptin, saxagliptin, sitagliptin, teneligliptin, vildagliptin), five traditional anti-diabetic drugs (insulin, metformin, sulfonylurea, thiazolidinedione, α-glucosidase inhibitors), two more recent drugs (glucagon-like peptide-1 receptor agonists, sodium/glucose cotransporter inhibitors) and placebo. We found: significantly reduced risk of hypoglycaemia for saxagliptin (OR 0.26, 95% CI 0.08 to 0.83) and vildagliptin (OR 0.32, 95% CI 0.11 to 0.90) versus insulin; and alogliptin, linagliptin, saxagliptin, sitagliptin, teneligliptin and vildagliptin versus sulfonylurea (OR range 0.10 (95% CI 0.03 to 0.31) to 0.15 (95% CI 0.10 to 0.22)); but significantly increased risk for sitagliptin versus thiazolidinedione (OR 2.10, 95% CI 1.11 to 3.97). According to ranking probabilities, from the nine DPP-4 inhibitors, teneligliptin had the maximum probability of the lowest risk of hypoglycaemia, while anagliptin had the maximum probability of the highest risk.

Conclusion: Most DDP-4 inhibitors are likely to have reduced risk of hypoglycaemia in T2DM patients when compared with insulin or sulfonylurea, while sitagliptin was found to have increased risk when compared to thiazolidinedione. These results indicate the different effects of DPP-4 inhibitors on hypoglycaemic risk and the need for further specific research.

Funding received: This article was supported by National Natural Science Foundation of China (81302508).

Correspondence: Prof Siyan Zhan, Email: siyan-zhan@bjmu.edu.cn; Prof Feng Sun, Email: sunfeng@bjmu.edu.cn