Comparative Efficacy and Safety of Ipragliflozin vs. Sitagliptin for Type 2 Diabetes: A Systematic Review and Meta-Analysis

Objective: Type 2 diabetes mellitus (T2D) is a chronic metabolic disorder requiring effective management. Ipragliflozin (SGLT-2 inhibitor) and sitagliptin (DPP-4 inhibitor) are commonly used treatments with distinct mechanisms of action. Despite their widespread use, there are limited direct comparisons of their relative safety and metabolic effects. This systematic review and meta-analysis aimed to compare the efficacy and safety of ipragliflozin and sitagliptin in patients with T2D, focusing on their effects on glycemic control, metabolic parameters, and adverse events. Material and methods: A comprehensive search of multiple databases (PubMed, Scopus, Web of Science, EMBASE, and Cochrane) identified randomized controlled trials (RCTs) that compared ipragliflozin and sitagliptin in T2D patients. A total of 3680 studies were initially retrieved, and after screening and eligibility assessment, four RCTs met the inclusion criteria. Results: We included 530 patients, 261 who received ipragliflozin and 269 who received sitagliptin. Ipragliflozin significantly reduced fasting blood glucose (FPG) (mean difference: –7.69 mg/dL, p = 0.03) and systolic blood pressure (SBP) (mean difference: –4.27 mmHg, p = 0.0003) compared to sitagliptin. There was also a significant improvement in HDL-C (mean difference: 2.77 mg/dL, p = 0.004). Conclusion: Ipragliflozin demonstrated non-inferior efficacy in improving fasting glucose, systolic blood pressure, and HDL-C levels compared with sitagliptin. However, the higher incidence of adverse events with ipragliflozin necessitates careful consideration when selecting treatments for T2D patients. Further long-term studies are required to validate our findings.