Adding Gliptin (DPP-4) to Sulfonylurea Causes More Hypoglycemia

10 RCTs, n = 6500 pts, mean age 55-75, mean A1c 7.7%-8.6%
RR for hypoglycemia 52% higher with DPP-4 + SU vs SU + placebo
NNH = 17 at 6 mos and NNH = 8 at one year.
Risk similar for low- and high-dose gliptins.
Conclusion:  makes sense – SUs increase insulin levels and gliptins increase incretin levels -> lower glucagon and indirectly increase insulin levels.  So, decrease dose of SUs when starting a gliptin.
BMJ 2016 May 3; 353:i2231
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