A network meta-analysis 3 including 236 RCTs with a total of 176 310 participants assessed the efficacies of SGLT-2 inhibitors (SGLT-2i) , GLP-1 agonists (GLP-1a), and DPP-4 inhibitors (DPP-4i) on mortality and cardiovascular end points. SGLT-2i and GLP-1a were associated with significantly lower all-cause mortality than the control groups (placebo or no treatment). DPP-4i were not significantly associated with lower all-cause mortality (aRD 0.1%; HR, 1.02; 95% CrI 0.94 to 1.11) compared to control groups.
A Cochrane review [Abstract] 2 included 44 studies with a total of 13 036 subjects. DPP-4 inhibitors reduced HbA1c (table T1) compared with placebo but had little or no effect on fasting blood glucose and cardiovascular death.
Outcome | Effect estimate (95% CI) | Control - Risk with placebo | Risk with intervention - DPP-4 inhibitors | No. of participants (studies) |
---|---|---|---|---|
Mean difference in HbA1c %and [HbA1c mmol/mol] | -- | 0.62% lower (0.39 to 0.62 lower) and [6.8 mmol/mol lower (4.3 to 9.3 lower)] | 867 (7) | |
Death (all causes) | RR 0.89 (0.75 to 1.07) | 108 per 1000 | 96 per 1000 (81 to 115) | 4211 (6) |
All cardiovascular death | RR 0.93(0.77 to 1.11) | 77 per 1000 | 71 per 1000 (59 to 85) | 5897 (2) |
Weight (kg) | MD 0.16(-0.58 to 0.9) | 0.16 kg higher (0.58 lower to 0.9 higher) | 210 (2) | |
Primary/Secondary Keywords