Originally published by 2 Minute Medicine^® (view original article). Reused on AccessMedicine with permission.

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 Rating Level: 2 (Good)

The initial pharmacologic intervention for type 2 diabetes mellitus (T2DM) includes biguanides and dipeptidyl peptidase-4 (DPP-4) inhibitors. Interestingly, guidelines differ worldwide as to which of the two is the first-line therapy. This retrospective cohort study aimed to fill the gap of comparative studies between biguanides and DPP-4 inhibitors by looking at their effects on the incidence of cardiac and cerebrovascular events, diabetic complications, and cost. By looking at patient 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 onset of any diabetes-related event including diabetic nephropathy, renal failure, diabetic retinopathy, and diabetic peripheral neuropathy. The average daily cost of medications was also recorded. Of the participants included, 514 were treated with a biguanide whereas 2570 were treated with a DPP-4 inhibitor with none on insulin. The incidence of cardio-cerebrovascular composite outcome (including cardiac events, cerebrovascular events, and death) did not vary significantly between either treatment (p = 0.544). Similarly, no significant difference in diabetic complication rate was seen between either treatment (p = 0.290). The cost, however, was significantly lower for participants using a biguanide (p < 0.001) at 60.5 ± 70.9 yen for biguanides and 123.6 ± 64.3 yen for DPP-4 inhibitors. A mean difference of 63.1 yen is 0.41 USD a day. The main limitation of this study for application outside of Japan where the study was conducted is the generalizability to another population as Japan is a highly homogenous society ethnically. However, similar studies should be conducted in other countries as this comparison is necessary to the treatment of patients worldwide.

Click to read the study in PLOSONE

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