Summary of findings 5. Summary of findings: DPP‐4 inhibitors.
| Combinations of insulin and dipeptidyl peptidase 4 inhibitors compared with insulin monotherapy for diabetes mellitus | |||||
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Patient: participants with type 2 diabetes mellitus Settings: mostly secondary care outpatients Intervention: dipeptidyl peptidase 4 (DPP‐4) inhibitors plus insulin Comparison: insulin monotherapy | |||||
| Outcomes | Insulin monotherapy | Insulin + DPP4‐inhibitor | No of participants (studies) | Quality of the evidence (GRADE) | Comments |
| All‐cause mortality | See comment | See comment | See comment | See comment | Not investigated |
| Diabetes‐related mortality | See comment | See comment | See comment | See comment | Not investigated |
| Diabetes‐related morbidity | See comment | See comment | See comment | See comment | Not investigated |
| Health‐related quality of life | See comment | See comment | See comment | See comment | Not investigated |
| Patient satisfaction | See comment | See comment | See comment | See comment | Not investigated |
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Adverse events: a. hypoglycaemia (% of participants) Follow‐up: 24 weeks to 52 weeks b. weight gain (kg) Follow‐up: 24 weeks to 52 weeks |
a. range 5%‐30% (0%‐5% severe) b. the mean weight gain across control groups ranged from 0.6 kg to 1.1 kg |
a. range 8%‐23% (0%‐2% severe) b. the mean weight gain in the intervention groups ranged from ‐0.7 kg to 1.3 kg compared to 0.6 kg to 1.1 kg in the insulin (+ placebo) monotherapy group |
a. 503 (3) b. 362 (2) |
a) ⊕⊕⊝⊝
lowa b) ⊕⊕⊝⊝ lowa |
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HbA1c, change from baseline (%) Follow‐up: 24 weeks to 52 weeks |
The mean change in HbA1c across control groups ranged from ‐0.2% to ‐0.3% | The mean change in HbA1c in the intervention groups was 0.4% lower (0.5% lower to 0.4% lower) | 265 (2) | ⊕⊕⊝⊝ lowa | |
| CI: confidence interval; DPP‐4: dipeptidyl peptidase 4; HbA1c: glycosylated haemoglobin A1c | |||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
aDowngraded by two levels because of unclear or high risk of bias in several risk of bias domains, indirectness and imprecision