Comparison of Efficacy 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 evaluate efficacy of Dipeptidyl peptidase-IV-inhibitor (DPP-4

inhibitors) compared to sulfonylureas (SU) in type two diabetes patients who were not adequately controlled

with metformin.

Method: Relevant articles were identified from PubMed, Scopus, Cochrane, Embase and some journals

websites, all studies published between 2007 until 2018 were included. Key words used were: Dipeptidyl

peptidase-IV-inhibitor, sulfonylurea, efficacy and cardiovascular. Both RCTs and Non- RCTs studies were

included

Results: Most of the studies that evaluated glycosylated hemoglobin (HbA1c) and fasting plasma glucose

reduction between SU and DPP-4 inhibitors revealed almost similar reduction rate. Accumulating evidences

showed no statistically significant difference between the two groups. Few studies claimed that SU had

better HbA1c reduction rate, however, with minimal significance.

In addition, evidence showed no significant effect on HDL or LDL. Sitagliptin associated with -5.3%

decreased in triglyceride level compared to 2.1% increased with glimepiride, resulting in a between-group

difference of ?6.1% (?10.4, ?1.7), favoring sitagliptin.

DPP-4 inhibitors added to metformin may be associated with fewer macrovascular complications compare

to SU combination with metformin.

Conclusion: It seems that DPP-4 inhibitors and SU has comparable glycemic control and overall efficacy

with no significant effect on HDL or LDL and slight effect on TG. DPP-4 inhibitors combination showed

fewer macrovascular complications.