2363-PUB: The Efficacy of Low vs. High FDA-Approved SGLT2 Inhibitor Dose Compared with DPP-4 Inhibitors: A Meta-analysis

All FDA-approved SGLT2 inhibitors (SGLT2i) are currently available in two doses. While most SGLT2i have demonstrated CV benefit, there may be a difference in hemoglobin A1c (A1c) reduction between both doses. We performed a meta-analysis to evaluate the efficacy of both SGLT2i doses compared to maximum DPP-4 inhibitor (DPP-4i) dose. We searched MEDLINE, EMBASE, CENTRAL, and CINAHL for randomized trials comparing at least one FDA-approved SGLT2i dose to maximum DPP-4i dose in type 2 diabetes and reporting a change in A1c. We performed two separate analyses according to dose (low SGLT2i dose vs. DPP-4i and high SGLT2i dose vs. DPP-4i). We included 12 trials. There was a significantly greater A1c reduction favoring lower SGLT2i dose compared to DPP-4i at ≥52 weeks (w) but not at ≤26 w (MD [95% CI] = -0.12% [-0.23, -0.02] and 0.00% [-0.06, 0.07] respectively) with an absolute A1c reduction of -0.76% vs. -0.75% at ≤26 w and -0.71% vs. -0.58% at ≥52 w respectively. When comparing higher SGLT2i dose vs. DPP-4i, there was a significantly greater A1c reduction for SGLT2i at ≤26 and ≥52 w (MD [95% CI] = -0.13% [-0.20, -0.05] and -0.26% [-0.36, -0.16] respectively) with an absolute A1c reduction of -0.91% vs. -0.77% at ≤26 w and -0.83% vs. -0.55% at ≥52 w respectively. We conclude that low SGLT2i dose had similar A1c reduction as DPP-4i in early treatment but became significant as treatment was prolonged. Higher SGLT2i dose is favored over DPP-4i.