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DPP-4 inhibitors for the treatment of type 2 diabetes: a methodology overview of systematic reviews

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Abstract

Aims

To evaluate the methodological quality of systematic reviews (SRs), and summarize evidence of important outcomes from dipeptidyl peptidase-4 inhibitors (DPP4-I) in treating type 2 diabetes mellitus (T2DM).

Methods

We included SRs of DPP4-I for the treatment of T2DM until January, 2018 by searching the Cochrane Library, PubMed, EMBASE and three Chinese databases. We evaluated the methodological qualities with the AMSTAR (Assessing the Methodological Quality of Systematic Reviews) tool and the GRADE (The Grading of Recommendations Assessment, Development and Evaluation) approach.

Results

Sixty-three SRs (a total of 2,603,140 participants) receiving DPP4-I for the treatment of T2DM were included. The results of AMSTAR showed that the lowest quality was “a list of studies (included and excluded) item” with only one (1.6%) study provided, followed by the “providing a priori design” item with only four (6.3%) studies conforming to this item, the next were “the status of publication (gray literature) used as an inclusion criterion item”, with only 18 (28.9%) studies conforming to these items. Only seven (11.1%) studies scored more than nine points in AMSTAR, indicating high methodological quality. For GRADE, of the 128 outcomes, high quality evidence was provided in only 28 (21.9%), moderate in 70 (54.7%), low in 27 (21.1%), and very low in three (2.3%).

Conclusions

The methodological quality of SRs of DPP4-I for type 2 diabetes mellitus is not high and there are common areas for improvement. Furthermore, the quality of evidence level is moderate and more high quality evidence is needed.

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Acknowledgements

We thank the library of Lanzhou University for their database in accessing and acquiring the full texts. The authors are also grateful to Dr. Karen Bysouth for polishing and revising the language. We would like to thank the authors of the original studies included in this overview.

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Authors and Affiliations

  1. School of Basic Medical Sciences, Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China

    Juan Ling, Long Ge, Jin-hui Tian & Ke-hu Yang

  2. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China

    Juan Ling, Long Ge, Jin-hui Tian & Ke-hu Yang

  3. Chinese GRADE Center, Lanzhou University, Lanzhou, China

    Juan Ling, Long Ge, Jin-hui Tian & Ke-hu Yang

  4. WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China

    Juan Ling, Long Ge, Jin-hui Tian & Ke-hu Yang

  5. The First Clinical Medical College of Lanzhou University, Lanzhou, China

    Long Ge

  6. Gansu University of Traditional Chinese Medicine, Lanzhou, China

    Ding-hua Zhang

  7. School of Basic Medical Sciences, Gansu University of Traditional Chinese Medicine, Lanzhou, China

    Yong-feng Wang

  8. Department of Endocrinology, Gansu Province Hospital of Traditional Chinese Medicine, Lanzhou, China

    Zhuo-lin Xie

  9. Gansu Provincial People’s Hospital, Lanzhou, China

    Xiao-hui Xiao

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The authors (Juan Ling, Long Ge, Ding-hua Zhang, Yong-feng Wang, Zhuo-lin Xie, Jin-hui Tian, Xiao-hui Xiao and Ke-hu Yang) have indicated that they have no conflicts of interest regarding the content of this article.

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Ling, J., Ge, L., Zhang, Dh. et al. DPP-4 inhibitors for the treatment of type 2 diabetes: a methodology overview of systematic reviews. Acta Diabetol 56, 7–27 (2019). https://doi.org/10.1007/s00592-018-1164-5

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