Objective: The use of dipeptidyl-peptidase 4 (DPP4) inhibitors and glucagon like peptide 1 (GLP1) analogues
for the treatment of diabetic mellitus (DM) type 2 is growing. Currently some of these agents have been approved in combination
with insulin. Methods: We considered randomised controlled trials (RCTs) evaluating GLP1 analogues or DDP4
inhibitors combined with basal insulin in diabetic patients. We were limited to trials published in English language.
Results: PubMed search retrieved 207 items. After excluding irrelevant items we ended with 7 eligible studies with 1808
participants. Mean baseline HbA1c was 8.5% and median follow up was 24 weeks. Exenatide combined with insulin was
used in 2 studies; DPP4 inhibitors were used in 5 studies (2 with sitagliptin, 1 with saxagliptin, 1 with vildagliptin and 1
with alogliptin). Conclusion: Incretin-based therapies combined with basal insulin are able to reduce HbA1c by 0.5-0.7%.
DPP4 inhibitors have no significant effect on weight, whereas GLP1 analogues reduced weight by 1-2 kg. Hypoglycaemia
rates were generally comparable in all treatment groups. These are promising results, but the available evidence is limited.
This is a poorly investigated field with few RCTs. New studies focusing on head-to-head comparisons with short-acting
insulin on top of basal insulin are needed.
Keywords: Exenatide, liraglutide, sitagliptin, saxagliptin, vildagliptin, alogliptin, insulin, diabetes mellitus.
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