SynthesisPloS one2025

RETRACTED: Cardiovascular and mortality outcomes of DPP-4 inhibitors vs. sulfonylureas as metformin add-on therapy in patients with type 2 diabetes: A systematic review and meta-analysis.

Refli Hasan, Uliana Y Chugaeva, Mahdi Mohammadian, Somayeh Zamanifard, Abdollah Mohammadian-Hafshejani

RetractedAbstract readSystematic ReviewMeta-AnalysisRetracted Publication
In one paragraph

Synthesis in PloS one, 2025. The graph read 2 numbers from its abstract, feeding 4 cells of the map: it . It has been retracted, and should not be counted. Cited by 2 papers.

2numbers the graph read from it
4cells of the map it votes in
2citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

← favours the treatmentfavours the comparator →
1 · no effect
All-cause mortalityDPP-4 inhibitors plus metformin vs sulfonylureas plus metforminfavours the treatment · ascvd, t2dfeeds 2 cells of the map
RR 0.790.71 to 0.88p < 0.001
Meta-analysis revealed a significantly lower risk of both major adverse cardiovascular events (risk ratio [RR]: 0.79; 95% confidence interval [CI]: 0.73-0.84; p < 0.001) and all-cause mortality (RR: 0.79; 95% CI: 0.71-0.88; p < 0.001) in patients with diabetes treated with DPP-4 inhibitors plus metformin compared to those treated with SUs plus metformin.
Major adverse cardiovascular eventsDPP-4 inhibitors plus metformin vs sulfonylureas plus metforminfavours the treatment · ascvd, t2dfeeds 2 cells of the map
RR 0.790.73 to 0.84p < 0.001
Meta-analysis revealed a significantly lower risk of both major adverse cardiovascular events (risk ratio [RR]: 0.79; 95% confidence interval [CI]: 0.73-0.84; p < 0.001) and all-cause mortality (RR: 0.79; 95% CI: 0.71-0.88; p < 0.001) in patients with diabetes treated with DPP-4 inhibitors plus metformin compared to those treated with SUs plus metformin.

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

DPP-4 inhibitors×all-cause mortality

No readable resultOpen on the map →What to test next →

No other readable study in this cell yet. This paper is the evidence.

Belief with this paper
0.50one trial · 1 family supports, 0 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.

DPP-4 inhibitors×cardiovascular events

No readable resultOpen on the map →What to test next →

3 readable studies in this cell: 2 favour the treatment, 1 find no difference, 0 favour the comparator.

Belief with this paper
0.99replicated · 2 families support, 0 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT01438814689 enrolled · 2011
OR 0.960.67 to 1.37

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

Metformin×all-cause mortality

No readable resultOpen on the map →What to test next →

1 readable study in this cell: 0 favour the treatment, 1 find no difference, 0 favour the comparator.

Belief with this paper
0.50one trial · 1 family supports, 0 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT000387272,779 enrolled · 1996
HR 0.990.79 to 1.25

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

Metformin×cardiovascular events

No readable resultOpen on the map →What to test next →

5 readable studies in this cell: 4 favour the treatment, 1 find no difference, 0 favour the comparator.

Belief with this paper
0.50contested · 4 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Article
6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

5 authors.

Refli HasanDepartment of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.
Uliana Y ChugaevaDepartment of Pediatric, Preventive Dentistry and Orthodontics, Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Mahdi MohammadianDepartment of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.
Somayeh ZamanifardDepartment of Cardiology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran.
Abdollah Mohammadian-HafshejaniEpidemiology, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.ORCID 0000-0003-1062-0097

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundType 2 diabetes significantly increase the risk of cardiovascular disease and mortality. This systematic review and meta-analysis compared cardiovascular and mortality outcomes in type 2 diabetes patients receiving dipeptidyl peptidase-4 inhibitors (DPP-4is) plus metformin versus sulfonylureas (SUs) plus metformin as add-on therapy.

methodsPubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, Google Scholar, and Scopus were searched through January 1, 2025, for studies comparing DPP-4is plus metformin versus SUs plus metformin in type 2 diabetes patients. Outcomes of interest were major adverse cardiovascular events and all-cause mortality. Heterogeneity was assessed using Cochran's Q test and I2 statistic. Publication bias was evaluated with Begg's and Egger's tests. Study quality was assessed with the Jadad scale (for randomized controlled trials) and the Newcastle-Ottawa Scale (for observational studies).

resultsTwenty-seven studies (2012-2024), encompassing 1,505,821 participants, were included in the analysis. Major adverse cardiovascular events were reported in 21 studies, and all-cause mortality data were available from 19 studies. Meta-analysis revealed a significantly lower risk of both major adverse cardiovascular events (risk ratio [RR]: 0.79; 95% confidence interval [CI]: 0.73-0.84; p < 0.001) and all-cause mortality (RR: 0.79; 95% CI: 0.71-0.88; p < 0.001) in patients with diabetes treated with DPP-4 inhibitors plus metformin compared to those treated with SUs plus metformin. No publication bias was detected.

conclusionIn type 2 diabetes patients treated with metformin, adding a DPP-4is is associated with significantly lower risks of major adverse cardiovascular events and all-cause mortality compared to adding an SUs. These findings underscore the potential cardiovascular benefits of DPP-4is and their role in improving patient outcomes.

Indexed as

Cardiovascular DiseasesDiabetes Mellitus, Type 2Dipeptidyl-Peptidase IV InhibitorsHypoglycemic AgentsMetforminSulfonylurea CompoundsDrug Therapy, CombinationHumansTreatment OutcomeDipeptidyl-Peptidase IV InhibitorsHypoglycemic AgentsMetforminSulfonylurea Compounds

Identifiers

PMID40323973
PMCPMC12083876

What Socratic holds

Texttitle and abstract
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.