COMPARISON BETWEEN THE EFFICACY OF SGLT2 INHIBITORS VERSUS DPP4 INHIBITORS IN INDIAN POPULATION: A SYSTEMATIC REVIEW
Main Article Content
Keywords
Type 2 Diabetes Mellitus, SGL2I, gliflozins, DPP4I, gliptins, Antidiabetic Agents, Indian population, Indians, India, Asians, SGLT2 Inhibitors versus DPP4 inhibitors
Abstract
Introduction: India is among the nations with the largest number of individuals having Diabetes Mellitus. Various elements liable for the increasing magnitude of type 2 diabetes include pathophysiologic and hereditary components as well as the 'Asian Indian phenotype', which makes these patients more prone to acquire T2DM in comparison to Caucasians. In this review efficacy and safety of dipeptidyl peptidase-IV inhibitors and sodium glucose transport inhibitor is going to be reviewed and compared with each other to ascertain effective and safe treatment options across the spectrum of T2DM patients in India.
Material and Methods: ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) 2015 guidelines’ were followed to report this systematic review with the inclusion of studies related to the use of oral hypoglycemic agents in Indian patients with type 2 Diabetes Mellitus and comparison between SGL2I and DPP4I in terms of efficacy, adverse effects, and other parameters. The search will be restricted to studies published in the English language on PubMed, Google Scholar, and the Indian Journal of Endocrinology and Metabolism (IJEM) from 2010 to 2021.
Results: The analysis of a number of studies revealed superiority of SGLT2I in several different parameters including reduction in HbA1c levels, improved glycemic control on follow up as well as positive effects on body weight and SBP reduction in comparison to the use of DPP4I. Moreover, use of SGLT2I showed improvement in the levels of TG and HDL-C values with modest worsening of LDL-C values. Reduction in fasting and postprandial glucagon levels was seen with the use of DPP4I in comparison to SGLT-2 inhibition resulting in more rapid insulin secretion and higher levels of intact incretin hormones. DPP4-I show a safe CV profile, however, the use of SGLT2-I resulted in better CV outcome and survival in DM patients as it significantly reduced the risk of all-cause death, CV death, MI and HF without any effect on stroke events. Adverse effects reported with the use of SGLT21 showed an increased risk of developing genital infection and in certain cases increased risk of amputations though not statistically significant. Although, DPP-4 inhibitors (gliptins) showed some positive cardiac and vascular effects in preliminary studies, an unexpected higher risk of hospitalization for heart failure was reported with saxagliptin. Conclusion: Overall, SGLT2I showed more efficacy than DPP4I and revealed superiority in several different parameters making it a more suitable option to improve health outcomes in Indian Diabetic patients
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16. Rosenstock J, Mathieu C, Chen H, Garcia-Sanchez R, Saraiva GL. Dapagliflozin versus saxagliptin as add-on therapy in patients with type 2 diabetes inadequately controlled with metformin. Arch Endocrinol Metab. 2018 Aug;62(4):424-430. doi: 10.20945/2359-3997000000056. PMID: 30304106.
17. Wang Z, Sun J, Han R, Fan D, Dong X, Luan Z, Xiang R, Zhao M, Yang J. Efficacy and safety of sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors as monotherapy or add-on to metformin in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Diabetes Obes Metab. 2018 Jan;20(1):113-120. doi: 10.1111/dom.13047. Epub 2017 Aug 10. PMID: 28656707.
18. Zilli RW, Rached CDA, Silva FPD, Baena RC. Long-term efficacy of gliflozins versus gliptins for Type 2 Diabetes after metformin failure: a systematic review and network meta-analysis. Rev Assoc Med Bras (1992). 2020 Apr;66(4):458-465. doi: 10.1590/1806-9282.66.4.458. PMID: 32578779.
19. Thayer S, Aguilar R, Korrer S, Chow W. HbA1c Outcomes in Patients Treated With Canagliflozin Versus Sitagliptin in US Health Plans. Clin Ther. 2017 Oct;39(10):2061-2072. doi: 10.1016/j.clinthera.2017.08.019. Epub 2017 Sep 22. PMID: 28943114.
20. Thayer S, Chow W, Korrer S, Aguilar R. Real-world evaluation of glycemic control among patients with type 2 diabetes mellitus treated with canagliflozin versus dipeptidyl peptidase-4 inhibitors. Curr Med Res Opin. 2016 Jun;32(6):1087-96. doi: 10.1185/03007995.2016.1159954. Epub 2016 Mar 16. PMID: 26938635.
21. Bailey CJ, Del Prato S, Wei C, Reyner D, Saraiva G. Durability of glycaemic control with dapagliflozin, an SGLT2 inhibitor, compared with saxagliptin, a DPP4 inhibitor, in patients with inadequately controlled type 2 diabetes. Diabetes Obes Metab. 2019 Nov;21(11):2564-2569. doi: 10.1111/dom.13841. Epub 2019 Aug 26. PMID: 31364269; PMCID: PMC6851837.
22. Wysham CH, Lefebvre P, Pilon D, Lafeuille MH, Emond B, Kamstra R, Pfeifer M, Duh MS, Ingham M. An investigation into the durability of glycemic control in patients with type II diabetes initiated on canagliflozin or sitagliptin: A real-world analysis of electronic medical records. J Diabetes Complications. 2019 Feb;33(2):140-147.
doi: 10.1016/j.jdiacomp.2018.10.016. Epub 2018 Oct 31. PMID: 30554838.
23. Bailey RA, Damaraju CV, Martin SC, Meininger GE, Rupnow MF, Blonde L. Attainment of diabetes-related quality measures with canagliflozin versus sitagliptin. Am J Manag Care. 2014 Jan;20(1 Suppl):s16-24. PMID: 24512193.
24. Bailey RA, Vijapurkar U, Meininger GE, Rupnow MF, Blonde L. Diabetes-related quality measure attainment: canagliflozin versus sitagliptin based on a pooled analysis of 2 clinical trials. Am J Manag Care. 2014 Dec;20(13 Suppl):s296-305. PMID: 25734218.
25. Bailey RA, Vijapurkar U, Meininger G, Rupnow MF, Blonde L. Diabetes-Related Composite Quality End Point Attainment: Canagliflozin Versus Sitagliptin Based on a Pooled Analysis of 2 Clinical Trials. Clin Ther. 2015 May 1;37(5):1045-54. doi: 10.1016/j.clinthera.2015.02.020. Epub 2015 Mar 18. PMID: 25795432.
26. Cha SA, Park YM, Yun JS, Lim TS, Song KH, Yoo KD, Ahn YB, Ko SH. A comparison of effects of DPP-4 inhibitor and SGLT2 inhibitor on lipid profile in patients with type 2 diabetes. Lipids Health Dis. 2017 Apr 13;16(1):58. doi: 10.1186/s12944-017-0443-4. PMID: 28403877; PMCID: PMC5390350.
27. Imre E, Gunhan HG, Erel P, Ustay O. SGLT2 inhibitors improve plasma atherogenic biomarkers in patients with type 2 diabetes: a real world retrospective observational study. Minerva Endocrinol (Torino). 2021 May 12. doi: 10.23736/S2724-6507.21.03465-5. Epub ahead of print. PMID: 33979071.
28. Liu Y, Xu J, Wu M, Xu B, Kang L. Empagliflozin protects against atherosclerosis progression by modulating lipid profiles and sympathetic activity. Lipids Health Dis. 2021 Jan 12;20(1):5. doi: 10.1186/s12944-021-01430-y. PMID: 33436015; PMCID: PMC7802233.
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Jan 15, 2024
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Pushkar Mani, Shipra jain, Ruchi Mathur, Mohammed Shoaib, & Aman Mathur. (2024). COMPARISON BETWEEN THE EFFICACY OF SGLT2 INHIBITORS VERSUS DPP4 INHIBITORS IN INDIAN POPULATION: A SYSTEMATIC REVIEW. Journal of Population Therapeutics and Clinical Pharmacology, 31(1), 605–616. https://doi.org/10.53555/jptcp.v31i1.4056
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Author Biographies
Pushkar Mani
Assistant Professor, Dept. of Pharmacology, Mahatma Gandhi Medical College & Hospital, Jaipur (Raj.)
Shipra jain
Professor, Dept. of Pharmacology, Mahatma Gandhi Medical College & Hospital, Jaipur (Raj.)
Ruchi Mathur
Sr. Resident, Dept. of Pharmacology, Mahatma Gandhi Medical College & Hospital, Jaipur (Raj.)
Mohammed Shoaib
Associate Professor, Dept. of Pharmacology, ITS Centre for Dental Studies and Research, Ghaziabad (UP)
Aman Mathur
Jr. Resident, Dept. of Pharmacology, Mahatma Gandhi Medical College & Hospital, Jaipur (Raj.)