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 review included studies in which linagliptin was given on its own or in combination with metformin, sulfonylurea  or pioglitazone.

The evidence

Nine studies were found, comprising 4,246 participants.

The reviewers conclude that linagliptin 5mg/day for 12-24 weeks significantly reduced hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG).  However, linagliptin monotherapy was not more effective than metformin at reducing HbA1c or FPG.

There was no evidence of more adverse events from linagliptin.

Appraisal hints

Users of this research should consider:

  • Did the review address a clearly focused question?
  • Was the search strategy comprehensive enough?
  • Were all the outcomes specified in advance of the review or was there some “data dredging” to find significant outcomes?
  • Were the quality assessments carried out by two independent reviewers?
  • What is the clinical significance of these benefits and would you expect your patients to get them?


Singh-Franco D, McLaughlin-Middlekauff J, Elrod S, Harrington C.  The effect of linagliptin on glycemic control and tolerability in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes Obes Metab. 2012 Feb 16.

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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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