***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIM To compare the long-term safety , tolerability and efficacy of saxagliptin vs. glipizide as add-on therapy to metformin . METHODS Adults with glycated haemoglobin ( HbA1c ) > 6.5 - 10 % ( on stable metformin ≥ 1500 mg/day ) were r and omised to saxagliptin 5 mg/day ( n = 428 ) or glipizide titrated from 5 to 20 mg/day ( mean dose 15 mg/day ; n = 430 ) for 52 weeks with a 52-week extension ( NCT00575588 ) . Assessment of the long-term safety , tolerability and efficacy of add-on saxagliptin vs. glipizide after 104 weeks was a tertiary objective of the initial 52-week study . RESULTS Saxagliptin was well tolerated during the 104-week period ; 67.1 % of patients receiving saxagliptin vs. 72.6 % receiving glipizide had ≥ 1 adverse event ( AE ) , and few patients ( 4.9 % vs. 5.6 % ) discontinued owing to AEs . Fewer patients treated with saxagliptin experienced hypoglycaemia ( 3.5 % vs. 38.4 % with glipizide ; difference , -34.9 % , 95 % CI , -39.8 to -30.0 ) or confirmed hypoglycaemia ( 0 vs. 9.1 % with glipizide ) . Weight loss was observed with saxagliptin ( -1.5 kg ) vs. weight gain with glipizide ( + 1.3 kg ; between-group difference , -2.8 kg , 95 % CI , -3.32 kg to -2.20 kg ) . Change from baseline in HbA1c was -0.41 ± 0.04 % with saxagliptin and -0.35 ± 0.04 % with glipizide ( between-group difference , -0.05 % , 95 % CI , -0.17 to 0.06 % ) . A post hoc analysis showed that the proportion of patients with baseline HbA1c ≥ 7 % who achieved HbA1c < 7 % ( observed data ) at week 104 was 23.1 % for saxagliptin + metformin and 22.7 % for glipizide + metformin . DISCUSSION AND CONCLUSION A lower risk of hypoglycaemia and reduced body weight were observed with saxagliptin vs. glipizide . No other clinical ly significant differences were observed between groups in safety profile . No significant between-group differences were observed for reductions in glycaemic parameters . After week 24 , a smaller weekly rise in HbA1c was observed with saxagliptin vs. glipizide as add-on therapy to metformin OBJECTIVES This study evaluated if triple oral therapy can be useful in improving glycemic control compared with metformin monotherapy and with a metformin and pioglitazone combination . Furthermore , we also compared a triple metformin+pioglitazone+glibenclamide combination with a metformin+pioglitazone+sitagliptin one . SUBJECTS AND METHODS After a 2-year run-in therapy-augmenting phase with metformin and pioglitazone , 453 overweight , type 2 diabetes patients were r and omized to 1 year of sitagliptin versus 1 year of glibenclamide to evaluate , as the primary outcome , the variation of β-cell function both in a fasting state and after an euglycemic hyperinsulinemic and hyperglycemic clamp . As secondary outcomes we evaluated glycemic control and insulin resistance . RESULTS Both the triple therapy combinations were more effective in reducing glycated hemoglobin compared with metformin monotherapy and with dual therapy metformin+pioglitazone .  Fasting plasma insulin level and the homeostasis model assessment insulin resistance index were significantly increased by triple therapy with glibenclamide and decreased by the one with sitagliptin . Although sitagliptin did not change the homeostasis model assessment β-function index , this value was significantly increased by glibenclamide . The fasting plasma proinsulin level was decreased by sitagliptin . Triple therapy with sitagliptin greatly improved β-cell function measures compared with the glibenclamide one and also compared with metformin monotherapy and with the metformin+pioglitazone combination . CONCLUSIONS Dual combination therapy is more effective than monotherapy in improving glycemic control . When double therapy is not enough to reach an adequate glycemic control , sitagliptin should be preferred to glibenclamide as the third agent because of its positive effect on β-cells Aim The broadly used combination of metformin and sulphonylurea ( SU ) often fails to bring patients to glycaemic goal . This study assessed the efficacy and safety of vildagliptin as add-on therapy to metformin plus glimepiride combination in patients with type 2 diabetes mellitus ( T2DM ) who had inadequate glycaemic control . Methods A multicentre , double-blind , placebo-controlled study r and omized patients to receive treatment with vildagliptin 50 mg bid ( n = 158 ) or  placebo ( n = 160 ) for 24 weeks . Results After 24 weeks , the adjusted mean change in haemoglobin A1c ( HbA1c ) was −1.01 % with vildagliptin ( baseline 8.75 % ) and −0.25 % with placebo ( baseline 8.80 % ) , with a between-treatment difference of −0.76 % ( p < 0.001 ) . Significantly more patients on vildagliptin  achieved the HbA1c target < 7 % ( 28.3 % vs. 5.6 % ; p < 0.001 ) . The difference in fasting plasma glucose reduction  between vildagliptin and placebo was −1.13 mmol/l ( p < 0.001 ) . In subgroup of patients with baseline HbA1c ≤8 % , vildagliptin  reduced HbA1c by 0.74 % from baseline 7.82 % ( between-treatment difference : –0.97 % ; p < 0.001 ) with significantly more patients achieving the HbA1c target < 7 % ( 38.6 % vs. 13.9 % ; p = 0.014 ) . Vildagliptin was well tolerated with low incidence of hypoglycaemia , slightly higher than with placebo ( 5.1 % vs. 1.9 % ) and no clinical ly relevant weight gain . Conclusions Vildagliptin significantly improved glycaemic control in patients with T2DM inadequately controlled with metformin plus glimepiride combination . The addition of vildagliptin was well tolerated with low risk of hypoglycaemia and weight gain . This makes vildagliptin an attractive treatment option for patients failing on metformin plus SU particularly in patients with baseline HbA1c ≤8 % AIM to evaluate the efficacy and safety of adding sitagliptin or glimepiride to the treatment regimen of patients with type 2 diabetes mellitus and inadequate glycaemic control on metformin monotherapy . METHODS patients with type 2 diabetes and an HbA(1c ) of 6.5 - 9.0 % while on a stable dose of metformin ( ≥ 1500 mg/day ) combined with diet and exercise for at least 12 weeks were r and omized in a double-blind manner to receive either sitagliptin 100 mg daily ( N = 516 ) or glimepiride ( starting dose 1 mg/day and up-titrated , based upon patient 's self-monitoring of blood glucose results , to a maximum dose of up to 6 mg/day ) ( N = 519 ) for 30 weeks . The primary analysis assessed whether sitagliptin is non-inferior to glimepiride in reducing HbA(1c ) at week 30 ( based on the criterion of having an upper bound of the 95 % CI less than the prespecified non-inferiority bound of 0.4 % ) . RESULTS the mean baseline HbA(1c ) was 7.5 % in both the sitagliptin group ( n = 443 ) and the glimepiride group ( n = 436 ) . After 30 weeks , the least squares ( LS ) mean change in HbA(1c ) from baseline was -0.47 % with sitagliptin and -0.54 % with glimepiride , with a between-group difference ( 95 % CI ) of 0.07 % ( -0.03 , 0.16 ) . This result met the prespecified criterion for declaring non-inferiority . The percentages of patients with an HbA(1c ) < 7.0 % at week 30 were 52 and 60 % in the sitagliptin and glimepiride groups , respectively . The LS mean change in fasting plasma glucose from baseline ( 95 % CI ) was -0.8 mmol/l ( -1.0 , -0.6 ) with sitagliptin and -1.0 mmol/l ( -1.2 , -0.8 ) with glimepiride , for a between-group difference ( 95 % CI ) of 0.2 mmol/l ( -0.1 , 0.4 ) . The percentages of patients for whom hypoglycaemia was reported were 7 % in the sitagliptin group and 22 % in the glimepiride group ( percentage-point difference = -15 , p < 0.001 ) . Relative to baseline , sitagliptin was associated with a mean weight loss ( -0.8 kg ) , whereas glimepiride was associated with a mean weight gain ( 1.2 kg ) , yielding a between-group difference of -2.0 kg ( p < 0.001 ) . CONCLUSIONS in patients with type 2 diabetes and inadequate glycaemic control on metformin monotherapy , the addition of sitagliptin or glimepiride led to similar improvement in glycaemic control after 30 weeks . Sitagliptin was generally well tolerated . Compared to treatment with glimepiride , treatment with sitagliptin was associated with a lower risk of hypoglycaemia and with weight loss versus weight gain ( Clinical Trials.gov : NCT00701090 ) AIM To assess the efficacy and safety of saxagliptin vs. glipizide as add-on therapy to metformin in patients with type 2 diabetes mellitus and inadequate glycaemic control on metformin alone . METHODS AND PATIENTS A total of 858 patients [ age ≥ 18 years ; glycated haemoglobin ( HbA(1c ) ) > 6.5 - 10.0 % ; on stable metformin doses ≥ 1500 mg/day ] were r and omised 1 : 1 to saxagliptin  5 mg/day or glipizide up-titrated as needed from 5 to 20 mg/day for 52 weeks . The primary objective was to assess if the change from baseline HbA(1c ) achieved with saxagliptin plus metformin was non-inferior to glipizide plus metformin . RESULTS The per- protocol analysis demonstrated non-inferiority of saxagliptin vs. glipizide ; adjusted mean changes from baseline HbA(1c ) were -0.74 % vs. -0.80 % , respectively ; the between-group difference was 0.06 % ( 95 % CI , -0.05 % to 0.16 % ) . Treatment with saxagliptin vs. glipizide was associated with a significantly smaller proportion of patients with hypoglycaemic events ( 3.0 % vs. 36.3 % ; p < 0.0001 ) and a divergent impact on body weight ( adjusted mean change from baseline -1.1 kg with saxagliptin vs. 1.1 kg with glipizide ; p < 0.0001 ) . There was a significantly smaller rise in HbA(1c ) ( % /week ) from week 24 to 52 with saxagliptin vs. glipizide ( 0.001 % vs. 0.004 % ; p = 0.04 ) indicating a sustained glycaemic effect beyond week 24 . Excluding hypoglycaemic events , the proportion of patients experiencing adverse events ( AEs ) was similar ( 60.0 % saxagliptin vs. 56.7 % glipizide ) ; treatment-related AEs were less common with saxagliptin vs. glipizide ( 9.8 % vs. 31.2 % ) , attributable to the higher frequency of hypoglycaemia in glipizide patients . Discontinuation rates result ing from AEs were similar ( ∼4 % ) . CONCLUSION Saxagliptin plus metformin was well tolerated , provided a sustained HbA(1c ) reduction over 52 weeks , and was non-inferior to glipizide plus metformin , with reduced body weight and a significantly lower risk of hypoglycaemia There is an explosive growth of type 2 diabetes mellitus ( T2DM ) in South Korea . According to Korea National Health and Nutritional Examination Survey performed in 2011 , the prevalence of diabetes among the population of 30 years and old is 12.4 % , and the number of patients with 
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CONCLUSION The review shows that , in terms of clinical efficacy , there is no significant difference between DPP4-inhibitors and sulfonylurea when either is added to metformin mono-therapy .
In contrast , the safety assessment analysis showed a significant decrease in the risk of hypoglycemic events in patients using DPP4-inhibitors