Dipeptidyl peptidase-4 inhibitor and insulin combination treatment in type 2 diabetes and chronic kidney disease: a meta-analysis

Aims/introduction The union of dipeptidyl peptidase-4 (DPP-4) inhibitors and insulin in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) provides satisfactory glucose management without increasing adverse events (AEs). This research appraised the therapeutic effect and safety of combination therapy in patients with T2D and CKD. Materials and methods We did a meta-analysis of randomized controlled trials (RCTs) to analyze AEs, hypoglycemia, serious adverse events (sAEs), severe hypoglycemia, estimated glomerular filtration rate (eGFR), fasting plasma glucose (FPG), glycated hemoglobin (HbA1C), insulin dose, low density lipoprotein cholesterol (LDL-C), uric acid (UA), and weight between combination treatment groups and control groups by searching the Cochrane Library, Excerpta Medica Database (Embase), PubMed, and Web of Science databanks until October 2020. Results Five studies (6 trials, 1278 participants) that met the inclusion criteria. The evidence quality ranged from moderate to high. HbA1C (standardized mean difference (SMD) -0.29, 95% confidence interval (CI) -0.44 to -0.14) and insulin dose (SMD -0.16, 95% CI -0.29 to -0.02) were obviously smaller in the combination cure patients than in the control patients. Compared with the control groups, combination treatment did not increase AEs, hypoglycemia, sAEs, or severe hypoglycemia. Conclusions This study demonstrated the effectiveness and safety of DPP-4 inhibitors bonded with insulin in patients with T2D and CKD, but the protective actions of this cure on kidney and cardiovascular outcomes, as well as the functions of other DPP-4 inhibitors, need to be affirmed by more good-quality RCTs.