Add-On DPP-4 Inhibitors Could Significantly Raise Hypoglycemia Risk

Addition of dipeptidyl peptidase-4 (DPP-4) inhibitors to sulphonylureas in patients with type 2 diabetes is associated with a 50% increase in the risk of hypoglycemia, according to the results of a recent study.

Sulphonylureas alone have been known to increase hypoglycemia risk by about 20%, according to the authors of the study, but the effects of the combination of sulphonylureas and DPP-4 inhibitors is less well known.
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The researchers conducted a systematic review and meta-analysis of 10 studies of a total of 6546 participants, 4020 of which received DPP-4 inhibitors and sulphonylureas, and 2526 of which received placebo plus sulphonylureas.

Overall, the absolute risk of hypoglycemia was significantly higher in patients taking both DPP-4 inhibitors and sulphonylureas (12%) than in those taking placebo and sulphonylureas (7%). Further, the researchers calculated that there would be 1 instance of hypoglycemia in every 17 individuals treated with DPP-4 inhibitors plus sulphonylureas for 6 months or less, and 1 in every 8 treated for more than 1 year.

“Addition of DPP-4 inhibitors to sulphonylurea to treat people with type 2 diabetes is associated with a 50% increased risk of hypoglycemia and to one excess case of hypoglycemia for every 17 patients in the first 6 months of treatment,” they concluded. “This highlights the need to respect recommendations for a decrease in sulphonylureas dose when initiating DPP-4 inhibitors and to assess the effectiveness of this risk minimization strategy.”

—Michael Potts

Reference:

Salvo F, Moore N, Arnaud M, et al. Addition of dipeptidyl peptidase-4 inhibitors to sulphonylureas and risk of hypoglycaemia: systematic review and meta-analysis. BMJ. 2016;353:i2231.