No difference between TZDs and DPP-4 inhibitors or sulphonylureas added to metformin in type 2 diabetes

Some pills

Research question: In people with type 2 diabetes inadequately controlled with metformin, which additional oral therapy offers the greatest improvement in HbA1c? The reviewers just looked at glycaemic control in patients whose starting HbA1c was 7% or higher at 12 weeks or longer follow-up. The evidence: Eight randomised trials were found, which looked at various [read the full story…]

Possible adverse effects of DPP-4 inhibitors in type 2 diabetes


DPP-4 inhibitors, or “gliptins”, are a new oral therapy for type 2 diabetes.  This review set out to find evidence for their safety in long term use. Clinical question: In type 2 diabetes, do DPP-4 inhibitors have any adverse effects? The evidence: The reviewers found 67 randomised controlled trials that evaluated alogliptin, linagliptin, saxagliptin, sitagliptin, [read the full story…]

Review: efficacy of DPP-4 inhibitors is similar to other second line treatments for type 2 diabetes.

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This systematic review set out to assess the effectiveness of dipeptidyl peptidase-4 (DPP-4) inhibitors compared with other treatments at reducing HbA1c in type 2 diabetes. Clinical question: In type 2 diabetes not on insulin, do DPP-4 inhibitors, as compared with alternative treatments, reduce Hba1c? The comparators included metformin alone and in combination with other oral [read the full story…]

Welsh NHS recommends saxagliptin as an option in type 2 diabetes

The All Wales Medicines Strategy Group has published a recommendation regarding saxagliptin, the DPP-4 inhibitor (Onglyza®) Saxagliptin is recommended as an option for use within NHS Wales for the treatment of adult patients aged 18 years and older with type 2 diabetes mellitus to improve glycaemic control in combination with insulin (with or without metformin) [read the full story…]

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Linagliptin rejected by the NHS in Wales for use in type 2 diabetes due to lack of evidence of efficacy

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We previously reported systematic reviews of DPP-4 inhibitors.  Recently, the All Wales Medicines Strategy Group, the government agency charged with assessing the effectiveness of medicines and making recommendations about their use in the NHS in Wales, issued an evaluation of linagliptin, a DPP-4 inhibitor marketed under the brand name Trajenta. Clinical question: In patients with [read the full story…]

Limited evidence for GLP-1 analogs as second line treatment for type 2 diabetes

A syringe

There remains considerable uncertainty as to the next step for treatment of type 2 diabetes that has not been successfully controlled using metformin.  A recent systematic review looked at this issue. Clinical question: In type 2 diabetes inadequately controlled on metformin alone, what additional therapy improves glycemic control? The reviewers also looked at potential adverse [read the full story…]

Linagliptin improves glycemic control in type 2 diabetes.

Diagram showing how DPP 4 inhibitors work

Linagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that can increase insulin production and reduce blood glucose in type 2 diabetes.  A new systematic review looked for effects on glycemic control, biomarkers and incidence of adverse events. Clinical question: In type 2 diabetes, does linagliptin, compared with placebo, improve glycemic control or cause adverse events? The [read the full story…]

Lack of evidence to choose second line drug treatments for type 2 diabetes


For people with type 2 diabetes, metformin is the usual choice for first-line drug treatment.  However, there remains some uncertainty as to the best choice for second-line treatments if metformin alone fails to achieve adequate glycaemic control.  This systematic review set out to find out which is the most effective choice. The reviewers conducted a [read the full story…]