The efficacy and safety of Diptptidyl peptidase-4 inhibitors combined with insulin in patients with autoimmune diabetes: A updated meta-analysis

Abstract

Introduction

It is still controversial about the efficacy of Diptptidyl peptidase-4 (DPP4) inhibitors in the treatment of autoimmune diabetes, especially it is unclear whether different drugs have different efficacy for different subtypes of autoimmune diabetes.

Aims

To evaluated the efficacy and safety of different DPP-4 inhibitors (Sitagliptin or saxagliptin) combined with insulin in the treatment of different subtypes of autoimmune diabetes.

Methods

We searched PubMed, Embase, Cochrane library, Web of Science, Wanfang and CNKI databases from inception to August 2022 to identify correlational studies. Then, RevMan 5.4 and Stata 17.0 software were used to make forest plots. Weighted mean difference (WMD) or odds ratio (OR) with 95 %CI to evaluated the outcomes of Saxagliptin or Sitagliptin combined with insulin in the treatment of autoimmune diabetes.

Results

18 studies consisting of 811 patients were included. Our study revealed Sitagliptin or Saxagliptin both have decrease insulin dose without increase the occurrence of hypoglycemia and adverse event, regardless of subtypes of autoimmune diabetes. Saxagliptin did not statistically improve in glucose control and beta cell function in both LADA and T1DM. However, compared with T1DM, Sitagliptin decreased HbA1c and improved islet beta cell function in patients with LADA.

Conclusions

Sitagliptin combined with insulin therapy in patients with LADA significantly improve glucose control and beta cell function, decrease insulin dose without increasing the occurrence of hypoglycemia and adverse event. Further research in this field is required.

Clinical relevance

DPP-4 inhibitors combined with insulin therapy in patients with autoimmune diabetes significantly reduced blood glycemic, preserve islet beta cell function, decrease insulin dose, BMI and the incidence of hypoglycemia, and do not increase the incidence of adverse events.