Effect of Switching From an Anti-Diabetic Loose Dose Combination to a Fixed Dose Combination Regimen at Equivalent Dosage for 6 Months on Glycemic Control in Japanese Patients With Type 2 Diabetes: A Pilot Study

Abstract

BackgroundPatients with type 2 diabetes mellitus often take multiple anti-diabetic drugs for a long period. Fixed dose combination (FDC) therapy is expected to improve drug adherence for patients with diabetes. The effect of switching from a loose dose combination (LDC) regimen to an FDC regimen at equivalent dosage on glycemic control has not been evaluated fully. Therefore, we investigated the effect of switching from LDC to FDC at equivalent dosage for 6 months on glycemic control in Japanese patients with type 2 diabetes.MethodsThirty-eight Japanese patients with type 2 diabetes who were taking anti-diabetic drugs including pioglitazone + metformin, pioglitazone + alogliptin, or pioglitazone + glimepiride were enrolled. These drugs were switched to an FDC of Metact®, Liobel® or Sonias®, respectively, at equivalent dosage. Other anti-diabetic drugs and units of insulin were not changed during the study if possible. HbA1c and body weight were measured 0, 2, 4 and 6 months after switching from an LDC to FDC. We also conducted a questionnaire survey 2 months after the start of the FDC regimen.ResultsHbA1c levels at 2, 4, and 6 months were not significantly changed compared with prior to switching from an LDC to FDC regimen. Moreover, 74.2% of patients considered decreasing the number of drugs to be “very good” or “good”.ConclusionHbA1c levels did not differ between patients receiving LDC and FDC therapy at equivalent dosage in this study.

Comparison of persistence and adherence between fixed-dose combinations and two-pill combinations in Japanese patients with type 2 diabetes

“…Combining antidiabetic agents with complementary mechanisms of action is fundamental to the management of diabetes 16 . While FDCs have only recently been launched in Japan, they offer a method of simplifying complex regimens, reducing treatment burden through less frequent dosing and allowing multiple medications with complementary mechanisms of actions to be given in a single formulation 22 . In addition, novel once weekly administration schedules also allow regimen simplification, which may help improve treatment adherence 23,24 .…”

Treatment patterns, persistence and adherence rates in patients with type 2 diabetes mellitus in Japan: a claims-based cohort study

“…In Japan, it has been estimated that approximately 60% of patients with diabetes forget to take their medication at some stage 10. Non-adherence to antidiabetic medications is associated with increased healthcare expenditure and higher rates of hospitalisation and death 11 12. It has been suggested that use of a once-weekly DPP-4i or a fixed-dose combination (FDC) therapy may improve adherence in patients with T2DM 13.…”

“…It has been suggested that use of a once-weekly DPP-4i or a fixed-dose combination (FDC) therapy may improve adherence in patients with T2DM 13. A 10% increase in adherence has been linked with a 0.1% decrease in HbA1c 11 14. Recent studies suggest that dual-therapy schedules containing a DPP-4i may improve persistence relative to DPP-4i monotherapy,15 or SU-containing schedules 16…”

“… 10 Non-adherence to antidiabetic medications is associated with increased healthcare expenditure and higher rates of hospitalisation and death. 11 12 It has been suggested that use of a once-weekly DPP-4i or a fixed-dose combination (FDC) therapy may improve adherence in patients with T2DM. 13 A 10% increase in adherence has been linked with a 0.1% decrease in HbA1c.…”