Comparison of Safety and Economic Burden of Dipeptidyl Peptidase-4-Inhibitor Versus Sulfonylureas in Type 2 Diabetes Patients Inadequately Controlled with Metformin; A Narrative Review

Abstract

Objectives: The aim of this review is to compare safety and economic burden of Dipeptidyl peptidase-IV

inhibitor (DPP-4 inhibitors) with sulfonylureas (SU) in type two diabetic patients who was not achieve their

glycemic goals with metformin.

Method: Two independent researchers identified related articles using PubMed, Cochrane, Scopus, google

scholar and direct journals websites, all articles published between 2007 and 2018 that compare safety and

economic burden of DPP-4 inhibitors versus SU were selected. Key words used were; sulfonylurea, DPP-

4 inhibitors, safety, economic, cost effectiveness and incremental cost. both RCTs and Non- RCTs studies

were included.

Results: In general, SU has significantly higher incidence of hypoglycemia and weight gain compared to

DPP-4 inhibitors. Several studies shown that (3.12% up to 42%) of the patients who received SU experienced

hypoglycemia whereas (0% up to 7%) of the DPP-4 inhibitor recipient experienced hypoglycemia. In

addition, drug-related adverse events have been frequently documented in SU users compared to DPP-

4 inhibitor users. However, other adverse effect was not remarkable. Cost-effectiveness analysis studies

in different countries revealed that DPP-4 inhibitors - metformin combination with was cost-effective

compared to SU - metformin combination.

Conclusion: It seems that DPP-4 inhibitors and SU has comparable safety except for hypoglycemia and

weight gain which was higher with SU. DPP-4 inhibitors - metformin combination with was cost-effective

compared to SU - metformin combination.