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Efficacy and safety of combination therapy with an alpha-glucosidase inhibitor and a dipeptidyl peptidase-4 inhibitor in patients with type 2 diabetes mellitus: A systematic review with meta-analysis.

Efficacy and safety of combination therapy with an alpha-glucosidase inhibitor and a dipeptidyl peptidase-4 inhibitor in patients with type 2 diabetes mellitus: A systematic review with meta-analysis.
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Min SH, Yoon JH, Hahn S, Cho YM,


Min SH, Yoon JH, Hahn S, Cho YM, (click to view)

Min SH, Yoon JH, Hahn S, Cho YM,

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Journal of diabetes investigation 2017 09 26() doi 10.1111/jdi.12754
Abstract
AIMS/INTRODUCTION
The combination of dipeptidyl peptidase-4 (DPP4) inhibitors and alpha-glucosidase inhibitors (AGIs) may provide an additive or synergistic glucose lowering effect as they have a complementary mode of action. In this study, we examined the efficacy and safety of the addition of a DPP4 inhibitor to patients with type 2 diabetes (T2DM) inadequately controlled with an AGI.

MATERIALS AND METHODS
We conducted an electronic search of MEDLINE, EMBASE, the Cochrane Library, and Clinicaltrials. gov through October 2016. Randomized controlled trials written in English that compared DPP4i plus AGI (DPP4i/AGI) and placebo plus AGI (PCB/AGI) in patients with T2DM were selected. Data on the study characteristics, efficacy, and safety outcomes were extracted, and the risk of potential biases was assessed. The efficacy and safety of DPP4i/AGI and PCB/AGI were compared.

RESULTS
Of 756 potentially relevant published articles and 40 registered trials, 5 studies including 845 patients randomized to DPP4i/AGI and 832 patients randomized to PCB/AGI were included for meta-analysis. Compared to PCB/AGI, DPP4i/AGI exhibited a greater reduction in HbA1c (weighted mean difference -1.2%, 95% confidence interval -1.6 to -0.8), fasting plasma glucose, and 2-h postprandial plasma glucose levels, with no increase in body weight. The risks of hypoglycemia and gastrointestinal adverse events were similar between DPP4i/AGI and PCB/AGI.

CONCLUSIONS
Addition of a DPP4 inhibitor to patients with T2DM inadequately controlled with an AGI achieved better glycemic control without further increasing the risk of weight gain and hypoglycemia. This article is protected by copyright. All rights reserved.

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