Comparative Study on Adding Pioglitazone or Sitagliptin to Patients with Type 2 Diabetes Mellitus Insufficiently Controlled With Metformin

Abstract

BACKGROUND:Diabetes mellitus is a progressive disorder that often requires combination therapy.AIM:This study aimed to compare and study of add-on sitagliptin versus pioglitazone in patients with type 2 diabetes inadequately controlled with metformin.METHODS:This 12-week, randomised, open-label and single centre study compared sitagliptin (100 mg daily, n = 80) and pioglitazone (30 mg daily, n = 80) in type 2 diabetic patients whose disease was not adequately controlled with metformin.RESULTS:The mean change in HbA1c from baseline was -1.001 ± 0.83 with sitagliptin and -0.75 ± 1.20 with pioglitazone, and there were no significant difference between groups (P = 0.132). The mean change in fasting blood sugar (FBS) was -18.48 ± 33.32 mg/dl with sitagliptin and -20.53 ± 53.97 mg/dl with pioglitazone, and there were no significant difference between groups (P = 0.773). Sitagliptin caused 1.08 ± 2.39 kg decrease in weight, whereas pioglitazone caused 0.27 ± 2.42 kg increase in weight, with a between-group difference of 0.81 kg (P < 0.001). On the other hand, in sitagliptin group, there was greater improvement in lipid profile than pioglitazone group.CONCLUSION:Sitagliptin and Pioglitazone demonstrated similar improvements in glycemic control in type 2 diabetes mellitus patients whose diabetes had been inadequately controlled with metformin. Nevertheless, sitagliptin was more effective than pioglitazone regarding lipid and body weight change.

Effective Reduction of Inflammatory and Coagulation Factors using Sitagliptin in Type 2 Diabetes

“…Similarly, Khaloo et al (7) reported that sitagliptin and pioglitazone had similar effects on the level of HbA1c. Jameshorani et al (20) also reported the similar effects of sitagliptin and pioglitazone in combination with metformin on the improvement of HbA1c. In addition, Liu et al (13) indicated the effectiveness of sitagliptin and pioglitazone in the reduction of HbA1c level; nonetheless, a greater FBS reduction was observed in response to pioglitazone, compared to that reported for sitagliptin.…”

Comparison Between Pioglitazone/Metformin Combination Therapy and Sitagliptin/Metformin Combination Therapy on the Efficacy in Chinese Type 2 Diabetic Adults Insufficiently Controlled with Metformin: Study Protocol of an Open-Label, Multicenter, Non-Inferiority Parallel-Group Randomized Controlled Trial

“…Findings regarding the comparative effects of the drugs on HbA1c reduction are mixed, with some studies reporting that pioglitazone was superior to sitagliptin, [21][22][23] and others not supporting this finding. [24][25][26] Reasons for these inconsistent findings may include different pioglitazone dosages, different drug combinations, and varying treatment durations. However, results specific to body weight change, tolerability, and safety profiles were quite consistent.…”

“…Specifically, these studies reported that pioglitazone was inferior to sitagliptin in terms of weight control, and both drugs were generally well tolerated. [21][22][23][24][25][26] noting that none of the studies based their conclusion on patients with T2D from mainland China. A propensity score-matched analysis found that compared with DPP4 inhibitors, TZD was significantly better at alleviating IR and inferior at improving β cell function.…”