Comparison of Effects of Dipeptidyl Peptidase-4 Inhibitors and Sulfonylureas in Combination with Metformin: A Hospital-Based Cohort Study of Patients With Type 2 Diabetes.

IF 3.2 4区医学 Q2 PHARMACOLOGY & PHARMACY

Clinical therapeutics Pub Date : 2025-06-26 DOI:10.1016/j.clinthera.2025.06.001

Jui Wang, Kuo-Liong Chien, Hon-Yen Wu

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引用次数: 0

Abstract

Purpose: The influence of dipeptidyl peptidase-4 inhibitors (DPP4i) on clinical parameters in patients with type 2 diabetes (T2DM) remain controversial. This study compared the effects of DPP4i versus sulfonylureas (SU) on glucose, lipid, and renal profiles among patients with T2DM.

Methods: In this retrospective cohort study, we used the Integrated Medical Database of National Taiwan University Hospital (NTUH-iMD) to identify patients aged ≥40 years with T2DM diagnosed between 2008 and 2016. Using propensity score matching at a ratio of 1:1, we matched patients who received DPP4i with those who received SU as add-on therapy to metformin. The primary outcomes were changes in blood levels of clinical profiles, including hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), total cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol, creatinine, and estimated glomerular filtration rate.

Findings: A total of 475 matched pairs of DPP4i and SU users were followed for a mean duration of 2.0 years. Both DPP4i and SU significantly reduced HbA1c, FPG, TC, TG, and LDL-C. Compared with SU, DPP4i showed a borderline greater reduction in HbA1c (effect estimate for the change of levels = -0.12%; 95% confidence interval (CI), -0.24% to 0%) and a nonsignificant difference in FPG (effect estimate for the change of levels = -4.09 mg/dL; 95% CI, -8.54 to 0.36 mg/dL).

Implications: Both DPP4i and SU improve glucose and lipid control in T2DM patients on metformin. DPP4i showed a modest advantage in improving glycemic control, suggesting it may be a preferred second-line therapy over SU.

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二肽基肽酶-4抑制剂与磺脲类药物联合二甲双胍的疗效比较：一项基于医院的2型糖尿病患者队列研究

目的：二肽基肽酶-4抑制剂（DPP4i）对2型糖尿病（T2DM）患者临床参数的影响尚存争议。本研究比较了DPP4i与磺脲类药物（SU）对T2DM患者血糖、脂质和肾脏的影响。方法：在这项回顾性队列研究中，我们使用国立台湾大学医院综合医学数据库（NTUH-iMD）识别2008年至2016年诊断的年龄≥40岁的T2DM患者。使用倾向评分匹配比例为1:1，我们将接受DPP4i的患者与接受SU作为二甲双胍附加治疗的患者进行匹配。主要结局是临床资料血液水平的变化，包括血红蛋白A1c （HbA1c）、空腹血糖（FPG）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白-胆固醇（LDL-C）、高密度脂蛋白-胆固醇、肌酐和肾小球滤过率。结果：共有475对匹配的DPP4i和SU使用者，平均随访时间为2.0年。DPP4i和SU均可显著降低HbA1c、FPG、TC、TG和LDL-C。与SU相比，DPP4i对HbA1c有更大的边缘性降低(水平变化的效应估计= -0.12%；95%置信区间（CI）， -0.24%至0%)和FPG无显著差异(水平变化的效应估计= -4.09 mg/dL；95%置信区间为-8.54 ~ 0.36 mg/dL)。意义：DPP4i和SU均能改善二甲双胍治疗的T2DM患者的血糖和脂质控制。DPP4i在改善血糖控制方面显示出适度的优势，这表明它可能是比SU更好的二线治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical therapeutics 医学-药学

CiteScore

6.00

自引率

3.10%

发文量

154

审稿时长

9 weeks

期刊介绍： Clinical Therapeutics provides peer-reviewed, rapid publication of recent developments in drug and other therapies as well as in diagnostics, pharmacoeconomics, health policy, treatment outcomes, and innovations in drug and biologics research. In addition Clinical Therapeutics features updates on specific topics collated by expert Topic Editors. Clinical Therapeutics is read by a large international audience of scientists and clinicians in a variety of research, academic, and clinical practice settings. Articles are indexed by all major biomedical abstracting databases.