Clinical and economical consequences of the combination of metformin with dipeptidyl peptidase inhibitors in type 2 diabetes patients

Mainar, Antoni Sicras; Suárez, C. Roldán; Ramos, B; Artieda, Ruth Navarro; Nolla, Jordi Ibáñez

doi:10.1016/j.rceng.2013.07.006

Cited by 5 publications

(7 citation statements)

References 26 publications

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“…The results of the present study confirm and extend conclusions from recent observational studies comparing adherence between DPP‐4 inhibitors and SUs (and/or other antidiabetic drugs), either alone or in combination with MET . For instance, the median treatment duration was nearly twofold higher with SITA (vs SU) + MET in a French primary care study: 43.2 versus 20.2 months ( P < 0.0001).…”

Section: Discussionsupporting

confidence: 88%

“…Similar findings were reported in a Spanish review of electronic medical records (EMRs) in primary care practices . compared with patients receiving MET + any antidiabetic therapy (including insulin), individuals treated with DPP‐4 inhibitors + MET exhibited significantly higher frequencies of adherence (70.3 % vs 59.6 %), persistence (63.4 % vs 51.0 %), and HbA1c <7 % (64.3 % vs 59.6 %; all P < 0.001).…”

Section: Discussionsupporting

confidence: 79%

“…compared with patients receiving MET + any antidiabetic therapy (including insulin), individuals treated with DPP‐4 inhibitors + MET exhibited significantly higher frequencies of adherence (70.3 % vs 59.6 %), persistence (63.4 % vs 51.0 %), and HbA1c <7 % (64.3 % vs 59.6 %; all P < 0.001). Recipients of DPP‐4 inhibitors (vs other therapies) also had significantly lower frequencies of hypoglycemia (13.9 % vs 44.3 %), cardiovascular events (3.7 % vs 7.6 %), and total costs (€2347 vs €2682; all P < 0.05) …”

Section: Discussionmentioning

confidence: 95%

“…35 The results of the present study confirm and extend conclusions from recent observational studies comparing adherence between DPP-4 inhibitors and SUs (and/or other antidiabetic drugs), either alone or in combination with MET. 24,[36][37][38] For instance, the median treatment duration was nearly twofold higher with SITA (vs SU) + MET in a French primary care study 36 : 43.2 versus 20.2 months (P < 0.0001). A multivariate analysis with PS adjustment determined that patients using SITA (vs SU) + MET were 30 % less likely to change treatment (relative risk 0.70; 95 % CI 0.62-0.78; P < 0.0001).…”

Section: Discussionmentioning

confidence: 99%

“…40 Similar findings were reported in a Spanish review of electronic medical records (EMRs) in primary care practices. 37 37 For many patients and their physicians, concerns about hypoglycemia and weight gain represent treatment barriers, potentially resulting in reduced adherence and/or a failure to intensify therapy despite suboptimal glucose control (i.e. treatment inertia 41 ), with decreased overall treatment effectiveness.…”

Section: Discussionmentioning

confidence: 99%

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Adherence, persistence, and treatment discontinuation with sitagliptin compared with sulfonylureas as add‐ons to metformin: A retrospective cohort database study

Bloomgarden

Tunceli

Liu

et al. 2016

Journal of Diabetes

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Background Data are limited regarding adherence to dipeptidyl peptidase‐4 inhibitors. Methods The present retrospective cohort study of a claims database involved adults with type 2 diabetes mellitus, continuous enrollment for 12 months before the first prescription of add‐on sitagliptin (SITA) or a sulfonylurea (SU) to metformin (MET) monotherapy (index date), and ≥45 days of MET coverage ≤90 days before the index date. The SITA and SU users were matched on duration of follow‐up and propensity score (PS). Logistic regression analysis incorporated age, gender, comorbidities, and concomitant medications as independent variables. Results Approximately 99 % of SITA patients were PS matched, resulting in 14 807 well‐balanced PS‐matched SITA/SU pairs. Mean proportion of days covered (PDC) was significantly higher for SITA (vs SU) + MET after 1 year (P < 0.001). Adherence (PDC ≥80 %) to SITA (vs SU) + MET was 59.1 % (vs 55.9 %; P < 0.001) at 1 year and 52.6 % (vs 49.9 %; P = 0.007) at 2 years. Using logistic regression models including out‐of‐pocket expense (OPE) as a covariate, we found improved mean PDC and adherence for SITA (vs SU) + MET. Numbers of patients who continued to use SITA (vs SU) + MET were significantly higher after Years 1, 2, and 3 (all P < 0.05). Conclusions Users of SITA + MET had significantly higher mean PDC, adherence, and persistence than those on SU + MET. These trends were robust to model alterations and were more marked when accommodating OPEs.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Adherence, persistence, and treatment discontinuation with sitagliptin compared with sulfonylureas as add‐ons to metformin: A retrospective cohort database study

Bloomgarden

Tunceli

Liu

et al. 2016

Journal of Diabetes

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Clinical outcomes and health care costs combining metformin with sitagliptin or sulphonylureas or thiazolidinediones in uncontrolled type 2 diabetes patients

Esposti¹,

Saragoni²,

Buda³

et al. 2014

CEOR

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ObjectivesTo compare clinical outcomes and health care costs across three cohorts of uncontrolled diabetic patients who initiated treatment with one of the following: sulphonylureas (SU), thiazolidinediones (TZD) or sitagliptin (SITA).Materials and methodsWe performed a retrospective study based on a linkage between administrative and laboratory databases maintained by three Italian local health units. The index period ranged from July 2008–June 2010. Patients were treatment-naïve to either SU, TZD, or SITA, but they were already treated with other oral hypoglycemic agents. Demographics and clinical characteristics were assessed at baseline. Adherence was measured by the medication possession ratio and adherent was defined as a patient with a medication possession ratio of 80% or greater. We used a Poisson regression model to estimate the risk ratios for disease-related hospitalizations that occurred during the 18-month follow-up period. The total annual costs included all the pharmacological treatments and the direct costs due to hospitalizations and outpatient services.ResultsWe identified 928 patients treated with SU, 330 patients treated with TZD, and 83 patients treated with SITA. SITA patients were significantly younger and with fewer previous hospital discharges. The baseline mean glycated hemoglobin level was 8.1% for SU, 8.0% for TZD, and 8.3% for SITA patients. SITA-naïve patients were more adherent than the SU- and TZD-naïve patients (79.5% versus 53.2% and 62.8%, respectively; P<0.001). The SU and TZD group showed a significant increased risk of disease-related hospitalizations compared with the SITA group (the unadjusted rate was 10.42 and 7.16 per 100 person-years versus 1.64 per 100 person-years, P=0.003; compared with SU, the adjusted incidence rate ratio for SITA was 0.21, P=0.030). The total annual costs per patient were €972 for SITA, €706 for SU, and €908 for those treated with TZD.ConclusionUncontrolled diabetic patients who initiated – as a second-line therapy in addition to metformin – treatment with SITA, compared to those who initiated treatment with SU or TZD, showed a reduced risk of disease-related hospitalizations. The total annual costs per patient were not significantly different among the three groups.

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Cost-of-Illness Study of Diabetes Mellitus: Focus on Patients with Type 2 Diabetes

Pirolo

Bettiol

Bolcato³

et al. 2016

Grhta

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In Veneto, il 4,7% della popolazione nel 2013 si dichiarava affetto da questa patologia (1); inoltre, in tale regione, la prevalenza è in costante aumento (+70% in 15 anni) con una conseguente generazione di costi a carico del Servizio Sanitario Regionale (SSR) (2). Nello scenario dell'assistenza sanitaria dei Paesi economicamente sviluppati le patologie croniche rappresentano la fonte di spesa maggiore (3) e, nell'ambito della patologia diabetica in Italia, la prima voce di costo è rappresentata dalle ospedalizzazioni (56,9% del costo totale) (4), dovute spesso all'aumento proporzionale del numero di complicanze (5).L'obiettivo dello studio è duplice: in primo luogo una valutazione dei costi sanitari diretti sostenuti per i pazienti diabetici in trattamento farmacologico assistiti dall'Az. ULSS 9 di Treviso; in secondo luogo, un'analisi dei costi di trattamento del diabete nei pazienti diabetici di tipo 2 non insulino-dipendenti, con anche un'analisi del tempo medio di mantenimento di questi pazienti in una data terapia (durability), per verificare l'ipotesi che una modifica del trattamento in corso, indicativa di un mancato controllo glicemico, si accompagni a una conseguente variazione dei costi.

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Clinical and economical consequences of the combination of metformin with dipeptidyl peptidase inhibitors in type 2 diabetes patients

Cited by 5 publications

References 26 publications

Adherence, persistence, and treatment discontinuation with sitagliptin compared with sulfonylureas as add‐ons to metformin: A retrospective cohort database study

Adherence, persistence, and treatment discontinuation with sitagliptin compared with sulfonylureas as add‐ons to metformin: A retrospective cohort database study

Clinical outcomes and health care costs combining metformin with sitagliptin or sulphonylureas or thiazolidinediones in uncontrolled type 2 diabetes patients

Cost-of-Illness Study of Diabetes Mellitus: Focus on Patients with Type 2 Diabetes

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