Both sodium glucose cotransporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase 4 inhibitors (DPP-4i) are effective drugs known to reduce hemoglobin A1c (A1c). While some guidelines favor SGLT2i over DPP-4i, there is no clear criteria in choosing between them. Potentially, baseline A1c could be one distinguishing factor. We performed a meta-analysis to explore the efficacy of SGLT2i compared to DPP-4i according to baseline A1c.

We searched MEDLINE, EMBASE, Cochrane CENTRAL, and CINAHL for randomized trials comparing SGLT2i to DPP-4i in type 2 diabetes and reporting a change in A1c stratified by baseline A1c. We pooled trials reporting outcomes based on baseline A1c <8.5% and ≥8.5%. For trials that reported results based on baseline hemoglobin A1c <8%, 8-9%, and >9%, we only used outcomes for baseline hemoglobin A1c <8% and >9% in the main analysis. Our primary outcome was change in A1c. A subgroup analysis was performed to compare both groups.

We included 6 trials. Although there was no significant difference between SGLT2i and DPP-4i when baseline A1c was <8.5%, results significantly favored SGLT2i when baseline A1c was ≥8.5% (MD [95% CI] = 0.04% [-0.09, 0.17] and -0.36% [-0.53, -0.18] respectively). Comparison between the two baseline A1c groups showed a significant difference (p=0.0004).

We conclude that baseline A1c should be considered when considering SGLT2i or DPP-4i. If A1c is ≥8.5%, SGLT2i should be favored over DPP-4i.


S.O. Page: None. B.M. Mishriky: None. J. Uhrig: None. K. Sewell: None. M.R. Mian: None. J.R. Powell: None. D.M. Cummings: None.

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