Economic Impact of Combining Metformin with Dipeptidyl Peptidase-4 Inhibitors in Diabetic Patients with Renal Impairment in Spanish Patients

Abstract

BackgroundTo evaluate resource use and health costs due to the combination of metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with diabetes and renal impairment in routine clinical practice.MethodsAn observational, retrospective study was performed. Patients aged ≥30 years treated with metformin who initiated a second oral antidiabetic treatment in 2009 to 2010 were included. Two groups of patients were analysed: metformin+DPP-4 inhibitors and other oral antidiabetics. The main measures were: compliance, persistence, metabolic control (glycosylated hemoglobin< 7%) and complications (hypoglycemia, cardiovascular events) and total costs. Patients were followed up for 2 years.ResultsWe included 395 patients, mean age 70.2 years, 56.5% male: 135 patients received metformin+DPP-4 inhibitors and 260 patients received metformin+other oral antidiabetics. Patients receiving DPP-4 inhibitors showed better compliance (66.0% vs. 60.1%), persistence (57.6% vs. 50.0%), and metabolic control (63.9% vs. 57.3%), respectively, compared with those receiving other oral antidiabetics (P<0.05), and also had a lower rate of hypoglycemia (20.0% vs. 47.7%) and lower total costs (€ 2,486 vs. € 3,002), P=0.001.ConclusionDespite the limitations of the study, patients with renal impairment treated with DPP-4 inhibitors had better metabolic control, lower rates (association) of hypoglycaemia, and lower health costs for the Spanish national health system.

Dipeptidyl Peptidase 4: A New Link between Diabetes Mellitus and Atherosclerosis?

“…Considering the glycemic control achieved by a combination of metformin with sulfonylureas or glitazones, gliptins provided comparable improvements [ 67 – 69 ], although with reduced risk of hypoglycemia and weight gain when compared to sulphonylureas and greater cost to the patients. However, in a recent retrospective analysis, gliptins in combination with metformin showed better metabolic control, lower rates of hypoglycemia, and even lower health costs in comparison to metformin and other oral agents in subjects with T2DM and renal impairment [ 70 ]. A study [ 71 ] comparing gliptins, sulphonylureas, insulin, and GLP-1 receptor agonists for use after metformin is ongoing and will possibly add knowledge about the most appropriate drugs for the treatment of T2DM.…”

Letter: Economic Impact of Combining Metformin with Dipeptidyl Peptidase-4 Inhibitors in Diabetic Patients with Renal Impairment in Spanish Patients (Diabetes Metab J2015;39:74-81)

“…In this article entitled "Economic impact of combining metformin with dipeptidyl peptidase-4 inhibitors in diabetic patients with renal impairment in Spanish patients," Sicras-Mainar and Navarro-Artieda [ 3 ] compared the total cost of DPP4 inhibitor and other oral anti-diabetics including sulfonylureas, glinides, and thiazolidinediones (TZDs) over 2 years of follow-up. The authors reported that the total economic cost of DPP4 inhibitor treatment could be lower than other oral antidiabetic (OAD) treatment for type 2 diabetic patients with renal impairment.…”

Response: Economic Impact of Combining Metformin with Dipeptidyl Peptidase-4 Inhibitors in Diabetic Patients with Renal Impairment in Spanish Patients (Diabetes Metab J2015;39:74-81)

“…We appreciate your interest and comments on our article entitled "Economic impact of combining metformin with dipeptidyl peptidase-4 inhibitors in diabetic patients with renal impairment in Spanish patients" which was published in Diabetes & Metabolism Journal [ 1 ].…”

“…The follow-up was 2 years. The study concluded that, in spite of the study limitations, patients with RI receiving metformin and DPP-4 inhibitors and had a greater probability of achieving better metabolic control and lower rates of hyperglycemia, and resulted in lower health costs for the Spanish National Health System [ 1 ].…”