COMPARISON BETWEEN THE EFFICACY OF SGLT2 INHIBITORS VERSUS DPP4 INHIBITORS IN INDIAN POPULATION: A SYSTEMATIC REVIEW
Main Article Content
Keywords
Type 2 Diabetes Mellitus, SGL2I, gliflozins, DPP4I, gliptins, Antidiabetic Agents, Indian population, Indians, India, Asians, SGLT2 Inhibitors versus DPP4 inhibitors
Abstract
Introduction: India is among the nations with the largest number of individuals having Diabetes Mellitus. Various elements liable for the increasing magnitude of type 2 diabetes include pathophysiologic and hereditary components as well as the 'Asian Indian phenotype', which makes these patients more prone to acquire T2DM in comparison to Caucasians. In this review efficacy and safety of dipeptidyl peptidase-IV inhibitors and sodium glucose transport inhibitor is going to be reviewed and compared with each other to ascertain effective and safe treatment options across the spectrum of T2DM patients in India.
Material and Methods: ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) 2015 guidelines’ were followed to report this systematic review with the inclusion of studies related to the use of oral hypoglycemic agents in Indian patients with type 2 Diabetes Mellitus and comparison between SGL2I and DPP4I in terms of efficacy, adverse effects, and other parameters. The search will be restricted to studies published in the English language on PubMed, Google Scholar, and the Indian Journal of Endocrinology and Metabolism (IJEM) from 2010 to 2021.
Results: The analysis of a number of studies revealed superiority of SGLT2I in several different parameters including reduction in HbA1c levels, improved glycemic control on follow up as well as positive effects on body weight and SBP reduction in comparison to the use of DPP4I. Moreover, use of SGLT2I showed improvement in the levels of TG and HDL-C values with modest worsening of LDL-C values. Reduction in fasting and postprandial glucagon levels was seen with the use of DPP4I in comparison to SGLT-2 inhibition resulting in more rapid insulin secretion and higher levels of intact incretin hormones. DPP4-I show a safe CV profile, however, the use of SGLT2-I resulted in better CV outcome and survival in DM patients as it significantly reduced the risk of all-cause death, CV death, MI and HF without any effect on stroke events. Adverse effects reported with the use of SGLT21 showed an increased risk of developing genital infection and in certain cases increased risk of amputations though not statistically significant. Although, DPP-4 inhibitors (gliptins) showed some positive cardiac and vascular effects in preliminary studies, an unexpected higher risk of hospitalization for heart failure was reported with saxagliptin. Conclusion: Overall, SGLT2I showed more efficacy than DPP4I and revealed superiority in several different parameters making it a more suitable option to improve health outcomes in Indian Diabetic patients
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