Effectiveness of sitagliptin compared to sulfonylureas for type 2 diabetes mellitus inadequately controlled on metformin: a systematic review and meta-analysis.

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sitagliptin 62 endocrinologydiseasesdrugs
tolbutamide 2 endocrinologydiseasesdrugs
type 2 diabetes mellitus 4 endocrinologydiseases
chlorpropamide 2 endocrinologydiseasesdrugs
diabetes mellitus 4 endocrinologydiseases
glipizide 3 endocrinologydiseasesdrugs
metformin 35 endocrinologydiseasesdrugs
pioglitazone 1 endocrinologydiseasesdrugs

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Select Drug Character Offset Drug Term Instance
chlorpropamide 7309 authorisation comparing sitagliptin with sulfonylureas (gliclazide, glipizide, glibenclamide, tolbutamide, chlorpropamide , glimepiride) in adults with T2DM inadequately controlled on metformin. We required that all studies
chlorpropamide 34517 increased mortality from cardiovascular disease with use of sulfonylureas particularly tolbutamide and chlorpropamide [43]; however, results from more recent RCTs with newer sulfonylureas like gliclazide are more reassuring.[43]
glipizide 7270 study conducted postmarketing authorisation comparing sitagliptin with sulfonylureas (gliclazide, glipizide , glibenclamide, tolbutamide, chlorpropamide, glimepiride) in adults with T2DM inadequately controlled
glipizide 13263 studies used glimepiride exclusively as the sulfonylurea comparator,[28] two studies exclusively used glipizide ,[32] while one study used glibenclamide.[31] Among the non-randomised studies, use of various sulfonylureas were
glipizide 17232 gliclazide were permitted only.BMI, body mass index; Glib, glibenclamide; Glim, glimepiride; Glip, glipizide ; HbA1c, haemoglobin A1c; Prosp, prospective; RCT, randomised controlled trial; Retro, retrospective;
metformin 126 OpenEffectiveness of sitagliptin compared to sulfonylureas for type 2 diabetes mellitus inadequately controlled on metformin : a systematic review and meta-analysisManuj SharmaNicholas BeckleyIrwin NazarethIrene Petersen [1]London
metformin 417 10/2017AbstractObjectiveTo assess the effectiveness of sitagliptin compared to sulfonylureas as add-on to metformin in adults with type 2 diabetes mellitus from both randomised controlled trials (RCTs) and ‘real-world’
metformin 2601 to address longer-term effectiveness outcomes for sitagliptin compared to sulfonylureas as add-on to metformin .PROSPERO registration numberCRD42016033983.Strengths and limitations of this studyWe provide a comprehensive
metformin 2829 examining a wide range of effectiveness outcomes for sitagliptin versus sulfonylureas as add-on to metformin .We assess and report evidence from both randomised clinical trials and ‘real-world’ non-randomised
metformin 3548 pharmacological treatments to achieve adequate control of the disease.[1] Most clinical guidelines recommend metformin as initial monotherapy; however, there is no consensus on second-line treatment.[1] This is further
metformin 3989 Sitagliptin has been the most extensively prescribed DPP-4 inhibitor in the UK and USA,[7] while alongside metformin , sulfonylureas such as gliclazide are the most widely prescribed oral antidiabetic agent for T2DM.[5]
metformin 4598 sitagliptin or a sulfonylurea as potential options to add-on in patients with T2DM inadequately controlled on metformin .[5]Clinical guidance from the American Association of Clinical Endocrinologists now recommends sitagliptin
metformin 6640 ascertain the effectiveness of sitagliptin compared to sulfonylureas in patients inadequately controlled on metformin . We examined a wide range of clinical effectiveness outcomes for which data have been reported.MethodsWe
metformin 7385 glibenclamide, tolbutamide, chlorpropamide, glimepiride) in adults with T2DM inadequately controlled on metformin . We required that all studies have a minimum of 1-month patient follow-up after initiation with sitagliptin
metformin 13774 study[38] to 72 months in the longest.[36] Four of the seven RCT studies required patients to be on metformin at a dose of ≥1500 mg at baseline,[28] while this was not required for any of the non-randomised
metformin 14603 2–4 mg24Aged ≥18 years and T2DM and baseline HbA1c ≥7.0% and ≤10.0% and prescribed metformin ≥1500 mg or maximum tolerated dose, BMI 20–45 kg/m2; creatinine clearance >60 mL/min; normal
metformin 14951 1–6 mg7.5Aged ≥18 years with T2DM and baseline HbA1c ≥6.5% and ≤9.0% and prescribed metformin ≥1500 mg/dayChange in HbA1C from baselineKim et al[30]RCT100 mgGlim 2 mg1Aged 18–80 years and
metformin 15142 2 mg1Aged 18–80 years and T2DM for <10 years baseline HbA1c ≥7.0% and ≤10.0% prescribed metformin and BMI 20–30 kg/m2Change in HbA1C from baselineKoren et al[31]RCT100 mgGlib 5 mg3Aged 18–75 years
metformin 15318 al[31]RCT100 mgGlib 5 mg3Aged 18–75 years and T2DM with baseline HbA1c ≥7.0% and prescribed metformin Change in arterial stiffness from baselineNauck et al[32]RCT100 mgGlip 5–20 mg12Aged 18–78 years
metformin 15502 5–20 mg12Aged 18–78 years and T2DM and baseline HbA1c ≥6.5% and ≤10.0% and prescribed metformin ≥1500 mg/dayChange in HbA1C from baselineSeck et al‡[33]RCT100 mgGlip 5–20 mg24Aged 18–78 years
metformin 15693 5–20 mg24Aged 18–78 years and T2DM and baseline HbA1c ≥6.5% and ≤10.0% and prescribed metformin ≥1500 mg/dayChange in HbA1C from baselineSrivastava et al[34]RCT50–200 mgGlim 1–4 mg4.5Aged
metformin 15891 1–4 mg4.5Aged ≥18 years with T2DM and baseline HbA1c ≥7.0% and ≤10.0% and prescribed metformin Change in HbA1C from baselineDerosa et al[35]Prosp. Cohort100 mgVar§60Aged >18 years with T2DM
metformin 16042 al[35]Prosp. Cohort100 mgVar§60Aged >18 years with T2DM and baseline HbA1c ≥8.0%, prescribed metformin and BMI 25–30 kg/m2).Change in HbA1C from baselineInzucchi et al[36]Retro. CohortVarVar§72Aged ≥18 years,
metformin 16191 HbA1C from baselineInzucchi et al[36]Retro. CohortVarVar§72Aged ≥18 years, initiated therapy with metformin in the 12 months preceding the index date on which sitagliptin/sulfonylurea initiatedRisk of insulin
metformin 16436 Cohort100 mgVar§6Aged ≥18 years with T2DM with a baseline HbA1c level ≥7.5% and prescribed metformin Change in HbA1C from baselineSuraj et al[38]Prosp. Cohort100 mgVar§3Aged 18–70 years with T2DM
metformin 16594 al[38]Prosp. Cohort100 mgVar§3Aged 18–70 years with T2DM and a baseline HbA1c ≥7.0% and prescribed metformin Change in HbA1C from baselineValensi et al[39]Prosp. Cohort100 mgVar§36Aged ≥18 years and prescribed
metformin 16712 HbA1C from baselineValensi et al[39]Prosp. Cohort100 mgVar§36Aged ≥18 years and prescribed metformin with inadequately controlled T2DM as determined by physician judgementRisk of need for treatment change*Duration
metformin 20296 same in both arms.†In Derosa et al, the authors compared several groups of patients prescribed with metformin (metformin and sulfonylurea, metformin and pioglitazone) and did not detail how many were in the metformin
metformin 20307 arms.†In Derosa et al, the authors compared several groups of patients prescribed with metformin ( metformin and sulfonylurea, metformin and pioglitazone) and did not detail how many were in the metformin and
metformin 20335 authors compared several groups of patients prescribed with metformin (metformin and sulfonylurea, metformin and pioglitazone) and did not detail how many were in the metformin and sulfonylurea group specifically.‡Median
metformin 20403 with metformin (metformin and sulfonylurea, metformin and pioglitazone) and did not detail how many were in the metformin and sulfonylurea group specifically.‡Median and IQR reported (not mean).§Seck et al is an extended
metformin 22492 due to a failure to adjust for important confounders such as age, sex, baseline HbA1c, weight and metformin dose in the final analysis.[38] Derosa et al achieved a low-quality rating as they had a strict cohort
metformin 29191 improvement after add-on of sitagliptin compared to sulfonylureas in individuals inadequately controlled on metformin . Statistically significant reduction in weight of approximately 2 kg was observed with sitagliptin
metformin 31281 informative.Glycaemic control achieved with sitagliptin or sulfonylureas in patients inadequately controlled on metformin was similar in our meta-analysis. Synergistic improvement in glycaemic effectiveness has been reported
metformin 31415 meta-analysis. Synergistic improvement in glycaemic effectiveness has been reported when sitagliptin and metformin are used together; however,[42] our study has shown that the glycaemic reduction results are similar
metformin 31551 however,[42] our study has shown that the glycaemic reduction results are similar to that achieved when metformin and sulfonylureas are used together. One RCT[34] and cohort study reported significant reductions in
metformin 33744 achieved in blood pressure or lipids through being prescribed sitagliptin or sulfonylureas as add-on to metformin . Cardiovascular outcome studies comparing sitagliptin to placebo have also been conducted recently[49];
metformin 35131 that will compare sitagliptin with sulfonylureas in individuals with T2DM inadequately controlled on metformin for longer-term complications.[57] However, the results of this trial are not expected until 2020, and
metformin 35585 effectiveness from both RCTs and non-randomised studies comparing sitagliptin with sulfonylureas as add-on to metformin . Secondly, we have reported data across a wide range of outcomes, and thirdly, we have undertaken meta-analysis
metformin 37586 effectiveness comparing sitagliptin with sulfonylureas among individuals with T2DM inadequately controlled on metformin for reducing longer-term complications of T2DM means treatments decisions for effectiveness (once safety
pioglitazone 20349 compared several groups of patients prescribed with metformin (metformin and sulfonylurea, metformin and pioglitazone ) and did not detail how many were in the metformin and sulfonylurea group specifically.‡Median and
sitagliptin 32 Title: BMJ OpenEffectiveness of sitagliptin compared to sulfonylureas for type 2 diabetes mellitus inadequately controlled on metformin: a systematic
sitagliptin 366 (collection): /2017Publication date (epub): 10/2017AbstractObjectiveTo assess the effectiveness of sitagliptin compared to sulfonylureas as add-on to metformin in adults with type 2 diabetes mellitus from both randomised
sitagliptin 1204 Meta-analysis of three homogenous RCTs revealed a statistically significant decrease in weight with sitagliptin when compared to sulfonylureas (weighted mean difference (WMD) −2.05 kg; 95% CI −2.38 to −1.71);
sitagliptin 2066 0.73) and insulin initiation (HR 0.76; 95% CI 0.65 to 0.90) were less likely among those prescribed sitagliptin ; however, inadequate reporting of HbA1c at time of treatment change made interpreting results challenging.ConclusionSitagliptin
sitagliptin 2550 effectiveness outcomes reported. Further studies are needed to address longer-term effectiveness outcomes for sitagliptin compared to sulfonylureas as add-on to metformin.PROSPERO registration numberCRD42016033983.Strengths
sitagliptin 2782 this studyWe provide a comprehensive overview examining a wide range of effectiveness outcomes for sitagliptin versus sulfonylureas as add-on to metformin.We assess and report evidence from both randomised clinical
sitagliptin 3230 elsewhere; however, we have summarised the safety literature in our introduction.We have focused on sitagliptin only as this is the most widely prescribed dipeptidyl-peptidase-4 inhibitor in the UK.IntroductionManagement
sitagliptin 4488 direct stimulation of β-cells in the pancreas.[8] Clinicians often have to choose between prescribing sitagliptin or a sulfonylurea as potential options to add-on in patients with T2DM inadequately controlled on metformin.[5]Clinical
sitagliptin 4703 metformin.[5]Clinical guidance from the American Association of Clinical Endocrinologists now recommends sitagliptin usage over sulfonylureas for second-line treatment[9]; however, most other major international guidelines
sitagliptin 5502 particularly in Eastern Asian countries as well.[6]From a safety perspective, both sulfonylureas and sitagliptin have been studied in considerable depth. To summarise, a several-fold higher risk of hypoglycaemia has
sitagliptin 5783 vulnerable population groups such as older individuals.[11] An increased risk of pancreatitis with sitagliptin has also been reported,[15] though absolute risk appears low, while conflicting evidence regarding a
sitagliptin 5946 appears low, while conflicting evidence regarding a worsening of heart failure in patients prescribed sitagliptin has been signalled.[8]Though safety of both treatments has been well evaluated, less has been characterised
sitagliptin 6105 treatments has been well evaluated, less has been characterised about the comparative effectiveness of sitagliptin compared to sulfonylureas from both randomised controlled trials (RCTs) and non-randomised studies using
sitagliptin 6317 using ‘real-world’ data.Several randomised placebo controlled trials have been conducted on both sitagliptin and sulfonylureas[17]; however, these do not facilitate direct comparison between the two. We carried
sitagliptin 6563 collate and analyse evidence from both RCTs and non-randomised studies to ascertain the effectiveness of sitagliptin compared to sulfonylureas in patients inadequately controlled on metformin. We examined a wide range
sitagliptin 7225 eligible if it was an RCT or non-randomised study conducted postmarketing authorisation comparing sitagliptin with sulfonylureas (gliclazide, glipizide, glibenclamide, tolbutamide, chlorpropamide, glimepiride)
sitagliptin 7491 metformin. We required that all studies have a minimum of 1-month patient follow-up after initiation with sitagliptin or sulfonylurea for outcomes (however, a minimum of 3 months was required for reported changes in HbA1c).Search
sitagliptin 9347 frequency). Reported intention-to-treat analysis results were used where possible. Outcomes examined compared sitagliptin and sulfonylurea for change from baseline in HbA1c (%), fasting plasma glucose (mmol/l), weight (kg),
sitagliptin 9915 included data examining the risk of needing treatment change or insulin initiation after commencement of sitagliptin compared to sulfonylureas. We also proposed to extract data on longer-term outcomes examining risk
sitagliptin 16254 CohortVarVar§72Aged ≥18 years, initiated therapy with metformin in the 12 months preceding the index date on which sitagliptin /sulfonylurea initiatedRisk of insulin initiationLee et al[37]Prosp. Cohort100 mgVar§6Aged ≥18 years
sitagliptin 16862 determined by physician judgementRisk of need for treatment change*Duration reported in months.†Only sitagliptin and sulfonylurea RCT arms considered.‡Seck et al is an extended follow-up study of Nauck et al; only
sitagliptin 17349 haemoglobin A1c; Prosp, prospective; RCT, randomised controlled trial; Retro, retrospective; Sita, sitagliptin ; Sulf, sulfonylureas; T2DM, type 2 diabetes mellitus.The characteristics of participants across the
sitagliptin 20695 meta-analysis.hbA1c, haemoglobin A1c, FPG, fasting plasma glucose; NR, not reported; SD, standard deviation; Sita, sitagliptin ; Sulf, sulfonylureas.Quality assessmentRisk of bias assessment for RCTsOut of seven RCTs, three studies
sitagliptin 23633 to double counting of patients. Meta-analysis showed that, compared to sulfonylureas, treatment with sitagliptin produced a similar glycaemic change, as measured by reductions in HbA1c from baseline: (weighted mean
sitagliptin 24049 was also meta-analysed across these three RCTs, and no significant difference was observed between sitagliptin and sulfonylureas (OR 0.98 95%; CI 0.85 to 1.13, I2=0%) (figure 2D). Only in the shorter 4.5-month
sitagliptin 24358 superior (mean difference (MD) in HbA1c 0.54%; 95% CI 0.43% to 0.64%).Figure 2Forest plots comparing sitagliptin and sulfonylureas for change from baseline in hbA1c (%) (A), weight (kg) (B), fasting plasma glucose
sitagliptin 24771 Observational study; OR, Odds ratio; Rct, Randomized controlled trial; SD, Standard deviation; Sita, sitagliptin ; Sulf, sulfonylureas; Tot, total participants. Note: Weights where present are from Fixed effects
sitagliptin 25572 changeMeta-analysis of the three RCTs that could be pooled showed statistically significant reduction in weight with sitagliptin from baseline compared to sulfonylureas (WMD −2.05 kg; 95% CI −2.38 to −1.71 kg; I2=0%)
sitagliptin 25807 equated to a modest weight increase of approximately 1 kg with sulfonylureas and loss of 1 kg with sitagliptin . Treatment with sitagliptin also showed significant reduction in weight in the remaining RCTs as shown
sitagliptin 25835 increase of approximately 1 kg with sulfonylureas and loss of 1 kg with sitagliptin. Treatment with sitagliptin also showed significant reduction in weight in the remaining RCTs as shown in figure 2B. The greatest
sitagliptin 26652 plasma glucoseMeta-analysis of the three RCTs showed that, compared to sulfonylureas, treatment with sitagliptin produced similar change in fasting plasma glucose (mmol/l) from baseline (WMD 0.11 mmol/L 95%; CI
sitagliptin 27185 demonstrated a more significant reduction in fasting plasma glucose with sulfonylureas compared to sitagliptin (MD 1.02 mmol/L; 95% CI 0.52 to 1.52 mmol/L).[38]Blood pressure and lipid changesTwo RCTs reported
sitagliptin 27336 1.52 mmol/L).[38]Blood pressure and lipid changesTwo RCTs reported no significant difference between sitagliptin and sulfonylureas for change in systolic and diastolic blood pressure, level of triglycerides and cholesterol
sitagliptin 27537 triglycerides and cholesterol between study end and baseline (figure 3A–D).Figure 3Forest plots comparing sitagliptin and sulfonylureas for change from baseline for systolic blood pressure (mm Hg) (A), diastolic blood
sitagliptin 27992 non-randomised observational study; Rct, randomised controlled trial; SD, standard deviation; Sita, sitagliptin ; Sulf, sulfonylureas.In the RCT led by Ahren et al, a clinically insignificant but statistically significant
sitagliptin 28162 clinically insignificant but statistically significant reduction in total cholesterol was observed with sitagliptin compared to sulfonylureas (MD −0.16 mmol/mol; 95% CI −0.29 to −0.03 mmol/mol).[28]Longer-term
sitagliptin 28513 36-month cohort study led by Valensi et al explored the risk of needing treatment change after add-on of sitagliptin compared to sulfonylureas (figure 3E).[39] They found that the adjusted risk of needing treatment change was
sitagliptin 28647 sulfonylureas (figure 3E).[39] They found that the adjusted risk of needing treatment change was lower with sitagliptin (HR 0.65; 95% CI 0.57 to 0.73).The 72-month cohort study led by Inzucchi et al demonstrated that individuals
sitagliptin 28781 0.57 to 0.73).The 72-month cohort study led by Inzucchi et al demonstrated that individuals prescribed sitagliptin had a lower risk for initiating insulin during follow-up after relevant adjustment (HR 0.76; 95% CI
sitagliptin 29111 which follow-up was greater than 6 months demonstrated similar glycaemic improvement after add-on of sitagliptin compared to sulfonylureas in individuals inadequately controlled on metformin. Statistically significant
sitagliptin 29290 metformin. Statistically significant reduction in weight of approximately 2 kg was observed with sitagliptin when compared to sulfonylureas driven by modest weight increase with sulfonylureas and modest decrease
sitagliptin 29411 compared to sulfonylureas driven by modest weight increase with sulfonylureas and modest decrease with sitagliptin . This may not be of clinical significance for most individuals other than those at more extremes of
sitagliptin 30066 of these high-quality non-randomised studies, results suggested that fewer individuals prescribed sitagliptin than sulfonylureas needed treatment change at 36-month and 72-month follow-ups, respectively.Meta-analysis
sitagliptin 31212 longer-term outcomes, we believe this study was made more informative.Glycaemic control achieved with sitagliptin or sulfonylureas in patients inadequately controlled on metformin was similar in our meta-analysis.
sitagliptin 31399 similar in our meta-analysis. Synergistic improvement in glycaemic effectiveness has been reported when sitagliptin and metformin are used together; however,[42] our study has shown that the glycaemic reduction results
sitagliptin 31721 study reported significant reductions in HbA1c and fasting glucose with sulfonylureas compared to sitagliptin ; however, these were both of 4.5 months in duration only.[38] This peak in sulfonylurea glycaemic efficacy
sitagliptin 32002 described.[43] For all studies of greater than 6-month duration, we found that glycaemic benefit with sitagliptin and sulfonylurea was comparable in line with guidance from major international bodies.[1]Statistically
sitagliptin 32146 in line with guidance from major international bodies.[1]Statistically significant weight loss with sitagliptin compared to sulfonylurea of approximately 2 kg was evident in our meta-analysis and also across all
sitagliptin 32386 studies reported up to 2 years in duration. This difference was driven by modest weight decrease with sitagliptin and increase with sulfonylureas. Sitagliptin is often described as having only a weight neutral effect[45];
sitagliptin 32964 only.[36] The risk of requiring a change in treatment or initiating insulin was found to be lower with sitagliptin , suggesting that sitagliptin patients are less likely to need treatment change over longer follow-up.
sitagliptin 32994 change in treatment or initiating insulin was found to be lower with sitagliptin, suggesting that sitagliptin patients are less likely to need treatment change over longer follow-up. However, decisions to change treatment
sitagliptin 33702 any clinically significant change being achieved in blood pressure or lipids through being prescribed sitagliptin or sulfonylureas as add-on to metformin. Cardiovascular outcome studies comparing sitagliptin to placebo
sitagliptin 33796 prescribed sitagliptin or sulfonylureas as add-on to metformin. Cardiovascular outcome studies comparing sitagliptin to placebo have also been conducted recently[49]; however, direct comparisons between a DPP-4 inhibitor
sitagliptin 34054 until 2019 on completion of the CAROLINA study.[50] This study will focus on use of linagliptin rather than sitagliptin , which raises a challenge as recent RCT results for different DPP-4 inhibitors were conflicting, raising
sitagliptin 35047 pragmatic clinical trial, the Glycemia Reduction Approaches in Diabetes, is underway that will compare sitagliptin with sulfonylureas in individuals with T2DM inadequately controlled on metformin for longer-term complications.[57]
sitagliptin 35540 review, to our knowledge, to assess effectiveness from both RCTs and non-randomised studies comparing sitagliptin with sulfonylureas as add-on to metformin. Secondly, we have reported data across a wide range of outcomes,
sitagliptin 36324 case across studies included. Moreover, our goal was to shed further light on the effectiveness of sitagliptin compared to sulfonylureas with a focus on the initial prescribing decision, and this was the most informative
sitagliptin 36509 decision, and this was the most informative approach to achieve this. Thirdly, our analysis has focused on sitagliptin only as it has been the most extensively prescribed DPP-4 inhibitor in the UK and USA.[7] Different
sitagliptin 37191 significance as evidence is emerging that suggests that glycaemic effectiveness of DPP-4 inhibitors like sitagliptin may in fact be greater in East Asians. This may be due to phenotypic variation in diabetes and highlights
sitagliptin 37499 different therapeutic approaches.[59]ConclusionsIn summary, the absence of data on effectiveness comparing sitagliptin with sulfonylureas among individuals with T2DM inadequately controlled on metformin for reducing longer-term
sitagliptin 37964 was similar. Statistically significant weight reduction of close to 2 kg was observed with use of sitagliptin when compared to sulfonylureas in both RCTs and non-randomised studies, though this may not be of major
sitagliptin 38235 Non-randomised studies also reported that there was a lower likelihood of treatment change after initiation of sitagliptin compared to sulfonylureas. However, it was difficult to interpret if this was necessarily a positive
tolbutamide 7296 postmarketing authorisation comparing sitagliptin with sulfonylureas (gliclazide, glipizide, glibenclamide, tolbutamide , chlorpropamide, glimepiride) in adults with T2DM inadequately controlled on metformin. We required
tolbutamide 34501 have reported increased mortality from cardiovascular disease with use of sulfonylureas particularly tolbutamide and chlorpropamide[43]; however, results from more recent RCTs with newer sulfonylureas like gliclazide
Select Disease Character Offset Disease Term Instance
diabetes mellitus 81 Title: BMJ OpenEffectiveness of sitagliptin compared to sulfonylureas for type 2 diabetes mellitus inadequately controlled on metformin: a systematic review and meta-analysisManuj SharmaNicholas BeckleyIrwin
diabetes mellitus 449 effectiveness of sitagliptin compared to sulfonylureas as add-on to metformin in adults with type 2 diabetes mellitus from both randomised controlled trials (RCTs) and ‘real-world’ non-randomised studies.Methods and
diabetes mellitus 3375 prescribed dipeptidyl-peptidase-4 inhibitor in the UK.IntroductionManagement of patients with type 2 diabetes mellitus (T2DM) is complex and often requires multiple pharmacological treatments to achieve adequate control
diabetes mellitus 17397 randomised controlled trial; Retro, retrospective; Sita, sitagliptin; Sulf, sulfonylureas; T2DM, type 2 diabetes mellitus .The characteristics of participants across the studies are summarised in table 2. The study population
type 2 diabetes mellitus 74 Title: BMJ OpenEffectiveness of sitagliptin compared to sulfonylureas for type 2 diabetes mellitus inadequately controlled on metformin: a systematic review and meta-analysisManuj SharmaNicholas BeckleyIrwin
type 2 diabetes mellitus 442 assess the effectiveness of sitagliptin compared to sulfonylureas as add-on to metformin in adults with type 2 diabetes mellitus from both randomised controlled trials (RCTs) and ‘real-world’ non-randomised studies.Methods and
type 2 diabetes mellitus 3368 widely prescribed dipeptidyl-peptidase-4 inhibitor in the UK.IntroductionManagement of patients with type 2 diabetes mellitus (T2DM) is complex and often requires multiple pharmacological treatments to achieve adequate control
type 2 diabetes mellitus 17390 RCT, randomised controlled trial; Retro, retrospective; Sita, sitagliptin; Sulf, sulfonylureas; T2DM, type 2 diabetes mellitus .The characteristics of participants across the studies are summarised in table 2. The study population

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