Background To compare the renal effects of dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose cotransporter 2 (SGLT2) inhibitors on individual outcomes in patients with type 2 diabetes.
Methods We searched electronic databases (MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials) from inception to June 2019 to identity eligible randomized controlled trials of DPP-4 inhibitors or SGLT2 inhibitors that reported at least one kidney outcome in patients with type 2 diabetes. Outcomes of interest were microalbuminuria, macroalbuminuria, worsening nephropathy, and end-stage kidney disease (ESKD). We performed an arm-based network meta-analysis using Bayesian methods and calculated absolute risks and rank probabilities of each treatment for the outcomes.
Results Seventeen studies with 87,263 patients were included. SGLT2 inhibitors significantly lowered the risks of individual kidney outcomes, including microalbuminuria (odds ratio [OR], 0.64; 95% credible interval [CrI], 0.41 to 0.93), macroalbuminuria (OR, 0.48; 95% CrI, 0.24 to 0.72), worsening nephropathy (OR, 0.65; 95% CrI, 0.44 to 0.91), and ESKD (OR, 0.65; 95% CrI, 0.46 to 0.98) as compared with placebo. However, DPP-4 inhibitors did not lower the risks. SGLT2 inhibitors were considerably associated with higher absolute risk reductions in all kidney outcomes than DPP-4 inhibitors, although the benefits were statistically insignificant. The rank probabilities showed that SGLT2 inhibitors were better treatments for lowering the risk of albuminuria and ESKD than placebo or DPP-4 inhibitors.
Conclusion SGLT2 inhibitors were superior to DPP-4 inhibitors in reducing the risk of albuminuria and ESKD in patients with type 2 diabetes.
Citations
Citations to this article as recorded by
Therapie des Typ-2-Diabetes Rüdiger Landgraf, Jens Aberle, Andreas L. Birkenfeld, Baptist Gallwitz, Monika Kellerer, Harald H. Klein, Dirk Müller-Wieland, Michael A. Nauck, Tobias Wiesner, Erhard Siegel Die Diabetologie.2024; 20(2): 212. CrossRef
Ipragliflozin and sitagliptin differentially affect lipid and apolipoprotein profiles in type 2 diabetes: the SUCRE study Mototsugu Nagao, Jun Sasaki, Kyoko Tanimura-Inagaki, Ichiro Sakuma, Hitoshi Sugihara, Shinichi Oikawa Cardiovascular Diabetology.2024;[Epub] CrossRef
Comparative Effect of Glucose-Lowering Drugs for Type 2 Diabetes Mellitus on Stroke Prevention: A Systematic Review and Network Meta-Analysis Ji Soo Kim, Gyeongsil Lee, Kyung-Il Park, Seung-Won Oh Diabetes & Metabolism Journal.2024; 48(2): 312. CrossRef
Therapy of Type 2 Diabetes Rüdiger Landgraf, Jens Aberle, Andreas L. Birkenfeld, Baptist Gallwitz, Monika Kellerer, Harald H. Klein, Dirk Müller-Wieland, Michael A. Nauck, Tobias Wiesner, Erhard Siegel Experimental and Clinical Endocrinology & Diabetes.2024;[Epub] CrossRef
Therapie des Typ-2-Diabetes Rüdiger Landgraf, Jens Aberle, Andreas L. Birkenfeld, Baptist Gallwitz, Monika Kellerer, Harald H. Klein, Dirk Müller-Wieland, Michael A. Nauck, Tobias Wiesner, Erhard Siegel Die Diabetologie.2023; 19(5): 658. CrossRef
Renoprotective Effect of Thai Patients with Type 2 Diabetes Mellitus Treated with SGLT-2 Inhibitors versus DPP-4 Inhibitors: A Real-World Observational Study Apichaya Chanawong, Suriyon Uitrakul, Supatcha Incomenoy, Natnicha Poonchuay, Rizky Abdulah Advances in Pharmacological and Pharmaceutical Sciences.2023; 2023: 1. CrossRef
Different nursing interventions on sleep quality among critically ill patients: A systematic review and network meta-analysis Daijin Huang, Yumei Li, Jing Ye, Chang Liu, Dongyan Shen, Yunhui Lv Medicine.2023; 102(52): e36298. CrossRef
New trends in the approach to the treatment of type 2 diabetes - observations and benefits in the outpatient practice of a diabetologist Pavel Weber, Hana Meluzínová, Dana Weberová Klinická farmakologie a farmacie.2022; 35(4): 118. CrossRef
Comparative efficacy of novel antidiabetic drugs on cardiovascular and renal outcomes in patients with diabetic kidney disease: A systematic review and network meta‐analysis Hongwei Cao, Tao Liu, Li Wang, Qiuhe Ji Diabetes, Obesity and Metabolism.2022; 24(8): 1448. CrossRef
Therapie des Typ-2-Diabetes Rüdiger Landgraf, Jens Aberle, Andreas L. Birkenfeld, Baptist Gallwitz, Monika Kellerer, Harald H. Klein, Dirk Müller-Wieland, Michael A. Nauck, Tobias Wiesner, Erhard Siegel Die Diabetologie.2022; 18(5): 623. CrossRef
Significant reduction in chronic kidney disease progression with sodium‐glucose cotransporter‐2 inhibitors compared to dipeptidyl peptidase‐4 inhibitors in adults with type 2 diabetes in a UK clinical setting: An observational outcomes study based on inte Iskandar Idris, Ruiqi Zhang, Jil B. Mamza, Mike Ford, Tamsin Morris, Amitava Banerjee, Kamlesh Khunti Diabetes, Obesity and Metabolism.2022; 24(11): 2138. CrossRef
Therapy of Type 2 Diabetes Rüdiger Landgraf, Jens Aberle, Andreas L. Birkenfeld, Baptist Gallwitz, Monika Kellerer, Harald Klein, Dirk Müller-Wieland, Michael A. Nauck, Tobias Wiesner, Erhard Siegel Experimental and Clinical Endocrinology & Diabetes.2022; 130(S 01): S80. CrossRef
Molecular Mechanistic Pathways Targeted by Natural Compounds in the Prevention and Treatment of Diabetic Kidney Disease Kaixuan Zhou, Xue Zi, Jiayu Song, Qiulu Zhao, Jia Liu, Huiwei Bao, Lijing Li Molecules.2022; 27(19): 6221. CrossRef
Lower risk of gout in sodium glucose cotransporter 2 (SGLT2) inhibitors versus dipeptidyl peptidase-4 (DPP4) inhibitors in type-2 diabetes Jiandong Zhou, Xuejin Liu, Oscar Hou-In Chou, Lifang Li, Sharen Lee, Wing Tak Wong, Qingpeng Zhang, Carlin Chang, Tong Liu, Gary Tse, Fengshi Jing, Bernard Man Yung Cheung Rheumatology.2022;[Epub] CrossRef
New Era for Renal-Protective Therapy in Type 2 Diabetes: Better Renal Outcomes in Patients with Type 2 Diabetes Taking Sodium-Glucose Cotransporter 2 Inhibitors versus Dipeptidyl Peptidase-4 Inhibitors Chan-Hee Jung Endocrinology and Metabolism.2021; 36(2): 339. CrossRef
Efficacy / safety balance of DPP-4 inhibitors versus SGLT2 inhibitors in elderly patients with type 2 diabetes André J. Scheen Diabetes & Metabolism.2021; 47(6): 101275. CrossRef