Adding Sitagliptin Does Not Reduce or Increase the Risk of Cardiovascular Outcomes


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Am Fam Physician. 2015 Dec 1;92(11):1020a-1021.

Clinical Question

Does adding sitagliptin (Januvia) to existing therapy for type 2 diabetes mellitus improve outcomes?

Bottom Line

The glass half full is that sitagliptin does not increase the risk of cardiovascular events in patients with type 2 diabetes. The glass half empty is that it does not reduce the risk, either. And that is the important message: In patients with a mean glycated hemoglobin level of 7.2%, adding sitagliptin at a cost of approximately $350 per month does not affect cardiovascular outcomes at all. (Level of Evidence = 1b)


To date, the only drug shown to reduce the risk of cardiovascular events or death in patients with type 2 diabetes is metformin. Sitagliptin is one of a class of dipeptidyl-peptidase-4 inhibitors that reduces glucose levels by decreasing glucagon levels and increasing insulin secretion. A previous meta-analysis found a 25% relative increase

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP,search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.


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