1. Biguanides and dipeptidyl peptidase-4 (DPP-4) inhibitors show no differences in major cardiac or cerebrovascular events, diabetic complications, or death in the Japanese population.

Evidence assessment level: 2 (Good)

The first line pharmacological intervention for type 2 diabetes mellitus (T2DM) includes biguanides and dipeptidyl peptidase 4 (DPP-4) inhibitors. Interestingly, there are different guidelines worldwide on which of the two therapies is the first line treatment. This retrospective cohort study aimed to fill the gap of comparative studies between biguanides and DPP-4 inhibitors by examining their effects on the incidence of cardiac and cerebrovascular events, diabetic complications and costs. Using patients’ treatment plans and codes for subsequent treatments, patients were assessed for the earliest cerebrovascular event, cardiac event or mortality as the primary outcome. Secondary outcomes included the occurrence of any diabetes-related events, including diabetic nephropathy, renal failure, diabetic retinopathy and diabetic peripheral neuropathy. Average daily medication costs were also recorded. Of the participants included, 514 were treated with a biguanide, while 2570 were treated with a DPP-4 inhibitor and none received insulin. The frequency of cardio-cerebrovascular combined outcomes (including cardiac events, cerebrovascular events and death) did not vary significantly between the two treatments (p = 0.544). Likewise, no significant difference was found in the diabetic complication rate between the two treatments (p = 0.290). However, costs were significantly lower for participants using a biguanide (p

Click here to read the study in PLOSONE

Image: PD

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