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Our aim was to explore whether the baseline hemoglobin A1c or the dose of sodium glucose cotransporter-2 inhibitor (SGLT-2i) chosen better predicted the efficacy of SGLT-2i versus dipeptidyl peptidase-4 inhibitor (DPP-4i) in type 2 diabetes. We searched for randomized trials that compared SGLT-2i with DPP-4i in type 2 diabetes and reported a change in hemoglobin A1c over time. We created 2 separate analyses (one based on baseline hemoglobin A1c and the other according to US Food and Drug Administration [FDA]-approved SGLT-2i dose). Thirteen trials were included. In the analysis according to baseline hemoglobin A1c , there was a significantly greater reduction in hemoglobin A1c when baseline hemoglobin A1c was ≥8.5%, favoring SGLT-2i over DPP-4i but not when baseline hemoglobin A1c was

Both sodium glucose cotransporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase 4 inhibitors (DPP-4i) are effective drugs known to reduce hemoglobin A1c (A1c). While some guidelines favor SGLT2i over DPP-4i, there is no clear criteria in choosing between them. Potentially, baseline A1c could be one distinguishing factor. We performed a meta-analysis to explore the efficacy of SGLT2i compared to DPP-4i according to baseline A1c. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and CINAHL for randomized trials comparing SGLT2i to DPP-4i in type 2 diabetes and reporting a change in A1c stratified by baseline A1c. We pooled trials reporting outcomes based on baseline A1c 9%, we only used outcomes for baseline hemoglobin A1c 9% in the main analysis. Our primary outcome was change in A1c. A subgroup analysis was performed to compare both groups. We included 6 trials. Although there was no significant difference between SGLT2i and DPP-4i when baseline A1c was We conclude that baseline A1c should be considered when considering SGLT2i or DPP-4i. If A1c is ≥8.5%, SGLT2i should be favored over DPP-4i. Disclosure S.O. Page: None. B.M. Mishriky: None. J. Uhrig: None. K. Sewell: None. M.R. Mian: None. J.R. Powell: None. D.M. Cummings: None.