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Comparative Effectiveness of GLP-1 Receptor Agonists vs DPP-4 Inhibitors in Type 2 Diabetes: A Systematic Review and Meta-Analysis
Martinez R, Chen L, Okafor K · Diabetes Care (2024)
Abstract
Background: This systematic review compared the clinical effectiveness of GLP-1 receptor agonists with DPP-4 inhibitors in adults with type 2 diabetes mellitus.
Methods: Thirty-four randomised controlled trials (n=28,042) were included. Eligible studies enrolled adults with type 2 diabetes receiving GLP-1 agonists or DPP-4 inhibitors for ≥12 weeks.
Results: GLP-1 agonists demonstrated superior HbA1c reduction (−0.4%, 95% CI −0.5 to −0.3) and significant weight loss compared with DPP-4 inhibitors.
Rationale
Study compares two pharmacological interventions for T2D management with clinical outcomes. Meets population, intervention, and outcome criteria per protocol.
PICOS Extraction
Adults with Type 2 Diabetes
GLP-1 receptor agonists
DPP-4 inhibitors
HbA1c, cardiovascular events
Randomized controlled trial
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Methods
Study Design: This multi-centre randomized controlled trial was conducted across 24 clinical sites in North America and Europe between January 2021 and December 2023.
Participants: We enrolled 1,842 adults aged 30–75 with confirmed type 2 diabetes and inadequate glycemic control (HbA1c 7.5–11.0%) on metformin monotherapy. Key exclusion criteria included renal impairment (eGFR <30), prior GLP-1RA use, and active cardiovascular disease.
Intervention: Participants were randomized 1:1 to semaglutide 1.0 mg weekly or standard of care for 52 weeks. The primary endpoint was change in HbA1c from baseline at week 52.
Rationale
RCT comparing GLP-1RA vs standard of care in T2D population with HbA1c and cardiovascular endpoints. Meets all eligibility criteria per protocol.
PICOS Extraction
Adults with Type 2 Diabetes
GLP-1 receptor agonists
Standard of care
HbA1c, weight, cardiovascular events
Randomized controlled trial
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Effects of Metformin on Glycemic Control in Adults with Type 2 Diabetes: A Multi-Centre Study
Johnson A, Smith B, Patel C, Williams D
Journal of Clinical Endocrinology & Metabolism, Vol 109 (3), 2024
Abstract
Background: This randomized controlled trial1 evaluated the efficacy of metformin monotherapy in newly diagnosed patients with type 2 diabetes across 12 clinical sites in North America and Europe.
Methods: A total of 245 adults aged 18–65 with confirmed type 2 diabetes2 were enrolled and randomized 1:1 to metformin 1 000 mg daily or matched placebo for 12 weeks. The primary endpoint was change in HbA1c from baseline.
Results: The primary endpoint of HbA1c reduction at 12 weeks3 showed significant improvement in the treatment group (−1.2% vs −0.3%, p<0.001). Secondary endpoints including fasting glucose and body weight also favoured metformin.
Study Design
Randomized Controlled Trial
Sample Size
245 participants
Population
Adults 18–65, Type 2 Diabetes
Primary Outcome
HbA1c reduction at 12 wk
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