Comparison of GLP-1 Receptor Agonists, SGLT-2 Inhibitors, and DPP-4 Inhibitors as an Add-On Drug to Insulin Combined With Oral Hypoglycemic Drugs: Umbrella Review.

Publisher: Hindawi Limited Country of Publication: England NLM ID: 101605237 Publication Model: eCollection Cited Medium: Internet ISSN: 2314-6753 (Electronic) NLM ISO Abbreviation: J Diabetes Res Subsets: MEDLINE

Publication: <2019>-: London, United Kingdom : Hindawi Limited
Original Publication: Nasr City, Cairo : Hindawi Publishing Corporation, [2013]-

Sodium-Glucose Transporter 2 Inhibitors*/therapeutic use ; Sodium-Glucose Transporter 2 Inhibitors*/administration & dosage ; Dipeptidyl-Peptidase IV Inhibitors*/therapeutic use ; Dipeptidyl-Peptidase IV Inhibitors*/administration & dosage ; Glucagon-Like Peptide-1 Receptor*/agonists ; Diabetes Mellitus, Type 2*/drug therapy ; Diabetes Mellitus, Type 2*/blood ; Hypoglycemic Agents*/therapeutic use ; Hypoglycemic Agents*/administration & dosage ; Hypoglycemic Agents*/pharmacology ; Insulin*/administration & dosage ; Drug Therapy, Combination*; Humans ; Blood Glucose/drug effects ; Blood Glucose/metabolism ; Glycated Hemoglobin/metabolism ; Treatment Outcome ; Administration, Oral ; Glucagon-Like Peptide-1 Receptor Agonists

Background: The objective was to evaluate the efficacy of the combination of Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), dipeptidyl peptidase-4 inhibitors (DPP-4i), and sodium-glucose cotransporter 2 inhibitor (SGLT-2i) in the treatment of Type 2 diabetes with poor efficacy of basic insulin and metformin/sulfonylurea by umbrella review. Materials and Methods: Forming the data of publication of each database through 13 September 2022, PubMed, EMBASE, and Cochrane Library were surveyed. Results: A total of seven meta-analyses were included in the umbrella review. The combination of GLP-1 RA (WMD -3.41 [-5.61, -1.21], p = 0.002), SGLT-2i (WMD -5.34 [-9.56, -1.13], p = 0.013), and DPP-4i (WMD -5.56 [-7.39, -3.73], p ≤ 0.001) can significantly reduce HbA1c levels, respectively. The combination of GLP-1 RA (WMD -1.55 [-2.92, -0.18], p = 0.027), SGLT-2i (WMD -2.96 [-6.68, 0.77], p = 0.12), and DPP-4i (WMD -2.05 [-2.82, -1.28], p ≤ 0.001) can significantly reduce fasting plasma glucose (FPG) levels, respectively. The combination of GLP-1 RA (WMD -3.24 [-5.14, -1.34], p < 0.001) can significantly reduce body weight of Type 2 diabetes mellitus (T2DM). The dose of basic insulin in diabetes patients after combined use of GLP-1 RA (WMD -2.74 [-4.26, -1.22], p ≤ 0.001) was significantly reduced. The combination use of GLP-1 RAs (OR 1.28 [1.05, 1.56], p = 0.017) increases the risk of hypoglycemia. Conclusions: The combination of GLP-1 RAs, DPP-4i, and SGLT-2i can effectively lower HbA1c and FPG in T2DM patients who have poor therapeutic effects on basic insulin combined with metformin/sulfonylureas, respectively. Compared to placebo, GLP-1 RAs can significantly reduce body weight and basic insulin dosage, while DPP-4i and SGLT-2i have a lower risk of hypoglycemia. Trial Registration: CRD42023410345.
Competing Interests: The authors declare no conflicts of interest.
(Copyright © 2024 Sanbao Chai et al.)

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Keywords: DPP-4; GLP-1; SGLT-2; Type 2 diabetes; basic insulin; umbrella review

0 (Sodium-Glucose Transporter 2 Inhibitors)
0 (Dipeptidyl-Peptidase IV Inhibitors)
0 (Glucagon-Like Peptide-1 Receptor)
0 (Hypoglycemic Agents)
0 (Insulin)
0 (Blood Glucose)
0 (Glycated Hemoglobin)
0 (Glucagon-Like Peptide-1 Receptor Agonists)

Date Created: 20240729 Date Completed: 20240729 Latest Revision: 20240730

20240730

PMC11283333

10.1155/2024/8145388

39072050