The objective of this review was to summarize and critically appraise the evidence regarding the clinical effectiveness and harms of combination use of dipeptidyl peptidase-4 (DPP-4) inhibitors or glucagon-like peptide-1 (GLP-1) analogues with insulin. The following research questions were assessed:

1. What is the clinical efficacy and safety of DPP-4 inhibitors used in combination with insulin for patients with inadequate glycemic control on a basal or biphasic insulin regimen?
2. What is the clinical efficacy and safety of GLP-1 analogues used in combination with insulin for patients with inadequate glycemic control on a basal or biphasic insulin regimen?

Contents

• ABBREVIATIONS
• 1. BACKGROUND
  • 1.1 Objective
• 2. METHODS
  • 2.1 Literature Search
  • 2.2 Eligibility Criteria
• 3. RESULTS
  • 3.1 Literature Selection
  • 3.2 Study Characteristics
  • 3.3 Addition of an Incretin versus Placebo
  • 3.4 Addition of DPP-4 Inhibitor versus Intensified Insulin
• 4. CRITICAL APPRAISAL
• 5. DISCUSSION
• REFERENCES
• APPENDIX 1 LITERATURE SEARCH STRATEGY

Suggested citation:

Canadian Agency for Drugs and Technologies in Health. Combination use of insulin and incretins in type 2 diabetes. Ottawa: The Agency; 2013. (CADTH optimal use report; vol.3, no. 1c).

This report is prepared by the Canadian Agency for Drugs and Technologies in Health (CADTH). The report contains a comprehensive review of the existing public literature, studies, materials, and other information and documentation (collectively the “source documentation”) available to CADTH at the time of report preparation.

The information in this report, when finalized, is intended to help Canadian health care decision-makers, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services. The information in this report should not be used as a substitute for the application of clinical judgment in respect of the care of a particular patient or other professional judgment in any decision-making process, nor is it intended to replace professional medical advice. While CADTH has taken care in the preparation of this document to ensure that its contents are accurate, complete, and up to date as of the date of publication, CADTH does not make any guarantee to that effect. CADTH is not responsible for the quality, currency, propriety, accuracy, or reasonableness of any statements, information, or conclusions contained in the source documentation. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or relating to the use (or misuse) of any information, statements, or conclusions contained in or implied by the information in this document or in any of the source documentation.

This document and the information provided are prepared and intended for use in the context of the Canadian health care system. Other health care systems are different; the issues and information related to the subject matter of this document may be different in other jurisdictions and, if used outside of Canada, it is at the user’s risk. This disclaimer and any questions or matters of any nature arising from or relating to the content or use (or misuse) of this document will be governed by and interpreted in accordance with the laws of the Province of Ontario and the laws of Canada applicable therein, and all proceedings shall be subject to the exclusive jurisdiction of the courts of the Province of Ontario, Canada.

CADTH takes sole responsibility for the final form and content of this document, subject to the limitations noted above. The statements and conclusions in this document are those of CADTH and not of its advisory committees and reviewers. The statements, conclusions, and views expressed herein do not necessarily represent the views of Health Canada or any Canadian provincial or territorial government. Production of this document is made possible by financial contributions from Health Canada and the governments of Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, Prince Edward Island, Saskatchewan, and Yukon.