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

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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, or vildagliptin.

When they pooled the data from these studies they found a significantly increased risk of asthenia and cardiovascular disorders.  When used in combination with insulin or sulphonylureas, they were associated with an increased risk of hypoglycaemia.

Appraisal hints:

Users of this research should consider:

  • The baseline risk of the adverse events studies in the review and the amount of uncertainty around these estimates of increased risk.
  • What other outcomes are reported in the study.
  • Are the studies similar enough to warrant combination?  Were any subgroup analyses carried out?

Reference:

Gooβen K, Gräber S. Longer-term safety of DPP-4 inhibitors in patients with type 2 diabetes mellitus: systematic review and meta-analysis. Diabetes Obes Metab. 2012 Apr 20. doi: 10.1111/j.1463-1326.2012.01610.x. [Epub ahead of print]

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Badenoch

Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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