Comparative Efficacy, Safety, and Cost-Utility of DPP-4 Inhibitors and Metformin Combination Therapy in Type 2 Diabetes: A Systematic Review of Real-World Clinical and Economic Outcomes
Abstract
INTRODUCTION: The management of type 2 diabetes with metformin as the first-line therapy has long been established. However, combination therapy of metformin and other oral antidiabetics became necessary to achieve optimal glycemic targets. Recently, the rising cost of these combinations poses a challenge for the healthcare system and patients, particularly in low- and middle-income settings, highlighting the need to balance clinical benefits with economic considerations to ensure access to treatment while maintaining sustainability in patient care. This review aims to compare the efficacy, safety, and cost-effectiveness of DPP-4 inhibitors with metformin/metformin with other combinations and metformin alone.
METHODS: A literature search was performed through databases including PubMed, Scopus, Cochrane, clinicaltrials.gov, and Google Scholar using specific keywords on "type 2 diabetes mellitus management," "metformin," "DPP-4 inhibitors," "safety," and "efficacy." The retrieved studies were screened and selected according to eligibility criteria, followed by data extraction and critical appraisal. The extracted data were synthesized and reported according to the PRISMA guidelines.
RESULTS: Thirty-five eligible studies were included in the review. From the studies, oral antidiabetic options apart from DPP-4 inhibitors commonly combined with metformin, either as free or fixed-dose combinations, include SGLT-2 inhibitors, sulfonylureas, GLP-1 receptor agonists, insulin, and…
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Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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