Efficacy and safety of sitagliptin and insulin for latent autoimmune diabetes in adults: A systematic review and meta-analysis.

Abstract

AIMS/INTRODUCTION:

The optimal therapy for latent autoimmune diabetes in adults (LADA) remains undefined. Increasing evidence has shown that sitagliptin and insulin treatment can benefit patients with LADA, but the efficacy still lacks systematic evaluation. We carried out this systematic review and meta-analysis to summarize the current data on the efficacy and safety of sitagliptin combined with insulin on LADA, providing a reliable reference for the effective therapeutic treatment of LADA patients.

MATERIALS AND METHODS:

We retrieved the literature in PubMed, Cochrane Library, Embase, Web of Science and CNKI from inception to August 2021. Randomized controlled trials comparing the effects of sitagliptin plus insulin with insulin alone in LADA patients were identified. The outcome measures included parameters of glycemic control, β-cell function, body mass index and adverse events. The Review Manager 5.2 and Stata 14.0 were utilized for data analysis.

RESULTS:

Eight randomized controlled trials involving 295 participants were identified. Sitagliptin and insulin treatment lowered hemoglobin A1c (weighted mean difference -0.36, 95% confidence interval -0.61 to -0.10, I2  = 91.6%), increased fasting C-peptide (weighted mean difference 0.08, 95% confidence interval -0.02 to 0.17, I2  = 88.8%) and had fewer adverse events compared with insulin alone. The inter-study heterogeneity, potential publication bias and other factors might interpret asymmetrical presentation of funnel plots. There was no significant association between sitagliptin plus insulin treatment and levels of hemoglobin A1c or fasting C-peptide, regardless of the duration of intervention and sample size.

CONCLUSIONS:

Sitagliptin combined with insulin can achieve better glycemic control and improve islet β-cell function with lower incidence of hypoglycemia compared with insulin alone, which provides an effective and tolerated therapeutic regimen for LADA patients. However, further well-designed and rigorous randomized controlled trials are required to validate this benefit due to the limited methodology quality of included trials.

• Authors: Tong Lin, Yinhe Cai, Liting Tang, Youwei Lian, Min Liu, Chaonan Liu
• Journal: Journal of diabetes investigation (J Diabetes Investig) Vol. 13 Issue 9 Pg. 1506-1519 (Sep 2022) ISSN: 2040-1124 [Electronic] Japan
• PMID: 35445591 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: © 2022 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Chemical References

• C-Peptide
• Dipeptidyl-Peptidase IV Inhibitors
• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin
• Sitagliptin Phosphate

Topics

• Adult
• C-Peptide
• Diabetes Mellitus, Type 2 (drug therapy)
• Dipeptidyl-Peptidase IV Inhibitors (therapeutic use)
• Glycated Hemoglobin
• Humans
• Hypoglycemic Agents (therapeutic use)
• Insulin (therapeutic use)
• Latent Autoimmune Diabetes in Adults (drug therapy)
• Randomized Controlled Trials as Topic
• Sitagliptin Phosphate (therapeutic use)