Evaluating Glycemic Control and Weight Reduction of SGLT2 Inhibitors Versus DPP-4 InhibitorsHigh dose SGLT2 inhibitors show better blood sugar control

ObjectiveTo systematically compare sodium-glucose linked transporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase 4 inhibitors (DPP4i) in glycemic control, weight reduction and genital infection risk in type 2 diabetic patients, and provide evidence-based support for individualized clinical medication.Materials and methodsA comprehensive search of PubMed, Web of Science, Cochrane Library, and EMBASE was performed for randomized controlled trials (RCTs) from database inception. Data on glycated hemoglobin, body weight, and genital infections were extracted. Risk of bias was assessed with the Cochrane ROB 2.0 tool. Meta-analyses were conducted using RevMan 5.4 and Stata 17.0, with effect sizes pooled by high- and low-dose SGLT2i subgroups. Subgroup analyses, sensitivity analyses, publication bias assessment (funnel plots plus Egger’s test), and GRADE evidence quality rating were performed.Results10 RCTs were ultimately included. For low-dose SGLT2i, the reduction in glycated hemoglobin was not statistically different from that of DPP4i (mean difference [MD] = 0.01%, 95% confidence interval [CI]: −0.05% to 0.07%, P = 0.75). In contrast, high-dose SGLT2i demonstrated superior glycemic efficacy (MD = −0.15%, 95% CI: −0.27% to −0.03%, P = 0.01). Regardless of dosage, SGLT2i were significantly more effective than DPP4i in reducing body weight (low-dose MD = −1.69, high-dose MD = −1.92; both P