Efficacy and Safety of Dipeptidyl Peptidase-4 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, and Sodium–Glucose Cotransporter-2 Inhibitors as Adjunctive Therapy to Automated Insulin Delivery System in Type 1 Diabetes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Pooled result · TIRResult — go to the resultDifference +10.0 % CI 7.4%–12.6%Authors' conclusion
SGLT-2i, DPP-4i, and GLP-1 RA may serve as effective and safe adjuncts for T1D individuals using AID systems, offering improvements in TIR, reductions in hyperglycemia, and reduced insulin requirements without evidence of increasing DKA and SH.
Study context
- Population
- T1D populations of any age using automated insulin delivery (AID) systems9 randomized controlled trials (RCTs)
- Comparison
- Noninsulin hypoglycemic drugs added to AID vs AID without adjunct
- Outcome
- TIR (70-180 mg/dL, 3.9-10.0 mmol/L)
Methodological detailsrandom-effect meta-analysis, Cochrane RoB2, GRADE
- Random-effect meta-analysis
- Cochrane RoB2
- GRADE
Pooled result
TIR
Difference
+10.0 %
CI 7.4%–12.6%
P < 0.001
As reported in the abstract
- TIR improvement with SGLT2i
- +12.5%
- TIR improvement with GLP-1 RA
- +7.1%
- TIR improvement with DPP-4i
- +6.4%
Further pooled results
| Outcome | Difference (%) (CI) | |
|---|---|---|
| TAR >250 mg/dL (>13.9 mmol/L)Noninsulin drug + AIDvs AID alone | −4.3 (−5.8 to −2.8) | |
| TAR >180 mg/dL (>10.0 mmol/L)Noninsulin drug + AIDvs AID alone | −11.6 (−14.7 to −8.5) | |
| Glycaemic CVNoninsulin drug + AIDvs AID alone | −2.9 (−4.5 to −1.4) | |
| −20−10010Difference, % (linear scale) |
| Outcome | Difference (%) (CI) | P value |
|---|---|---|
| Time in tight range (TITR; 70-140 mg/dL, 3.9-7.8 mmol/L)Noninsulin drug + AID vs AID alone · I2 15.4% · random-effect meta-analysis | +8.9 (6.8%–11.0%) | P < 0.001 |
Daily insulin dose
- Daily insulin dose decreased
- 8.9 units
TIR improvement by drug class
- SGLT-2i (greatest)
- +12.5%
- GLP-1 RA
- +7.1%
- DPP-4i
- +6.4%
Safety
Hypoglycaemia, severe hypoglycaemia and diabetic ketoacidosis (DKA)
- Improvements without increased hypoglycemia
- No significant differences in severe hypoglycemia and DKA
Original publication
Efficacy and Safety of Dipeptidyl Peptidase-4 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, and Sodium–Glucose Cotransporter-2 Inhibitors as Adjunctive Therapy to Automated Insulin Delivery System in Type 1 Diabetes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Diabetes Technol Ther. Published 4 February 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →