Effectiveness and safety of empagliflozin‐based quadruple therapy compared with insulin glargine‐based therapy in patients with inadequately controlled type 2 diabetes: An observational study in clinical practice

Ku, Eu Jeong; Lee, Dong Hwa; Jeon, Hyun Jeong; Oh, Tae Keun

doi:10.1111/dom.13476

Cited by 19 publications

(23 citation statements)

References 13 publications

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“…Recently, several real-world data from clinical practice settings were reported which showed similar glucose-lowering efficacy of SGLT2 inhibitors as add-on therapy to those from previous RCTs and meta-analyses [131415]. These findings were consistently observed in Korean patients with T2DM [161718]. In actual clinical practice, it may also be considered to change an OAD to other class of OAD if glycemic goal is not achieved, which means switch therapy.…”

Section: Introductionmentioning

confidence: 67%

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Efficacy and Safety of Sodium-Glucose Cotransporter-2 Inhibitors in Korean Patients with Type 2 Diabetes Mellitus in Real-World Clinical Practice

et al. 2019

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BackgroundThis study aimed to evaluate the efficacy and safety of sodium-glucose cotransporter-2 (SGLT2) inhibitors in Korean patients who had inadequately controlled type 2 diabetes mellitus (T2DM) in real-world clinical practice.MethodsWe included 410 patients who started SGLT2 inhibitors (empagliflozin or dapagliflozin) as add-on therapy or switch therapy between February 2015 and June 2017. The primary efficacy endpoint was a change in glycosylated hemoglobin (HbA1c) from baseline to week 12. The secondary endpoints were patients achieving HbA1c <7.0% and changes in the fasting plasma glucose (FPG), lipid profiles, body weight, and blood pressure (BP).ResultsThe mean HbA1c at baseline was 8.5% (8.6% in the add-on group and 8.4% in the switch group). At week 12, the mean adjusted HbA1c decreased by −0.68% in the overall patients (P<0.001), by −0.94% in the add-on group, and by −0.42% in the switch group. Significant reductions in FPG were also observed both in the add-on group and switch group (−30.3 and −19.8 mg/dL, respectively). Serum triglyceride (−16.5 mg/dL), body weight (−2.1 kg), systolic BP (−4.7 mm Hg), and diastolic BP (−1.3 mm Hg) were significantly improved in the overall patients. Approximately 18.3% of the patients achieved HbA1c <7.0% at week 12. A low incidence of hypoglycemia and genital tract infection was observed (6.3% and 2.2%, respectively).ConclusionSGLT2 inhibitors can be a suitable option as either add-on or switch therapy for Korean patients with inadequately controlled T2DM.

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Section: Introductionmentioning

confidence: 67%

“…There have been few real-world studies of SGLT2 inhibitors reported in Koreans. Previous two studies evaluated the efficacy and safety of dapagliflozin or empagliflozin-based quadruple therapy in Koreans [1718]. Another Korean study examined the efficacy of dapagliflozin and clinical characteristics of good responders to dapagliflozin [16].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Sodium-Glucose Cotransporter-2 Inhibitors in Korean Patients with Type 2 Diabetes Mellitus in Real-World Clinical Practice

et al. 2019

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“…Although the retrospective and observational nature of our study is a limitation, it has the advantage of reflecting the current state of T2D management in the real world. Although there have been a few studies on quadruple therapy in T2D, these studies focused on the effectiveness of SGLT2i-based quadruple regimen in patients with poorly controlled T2D and did not consider variable combinations of quadruple OHA therapies [7,8]. In addition, the major strength of our study was contributing additional evidence for recommendation or consideration of quadruple therapy for some patients in the future.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a quadruple combination of OHAs targeting various organs could be a feasible option for patients with poorly controlled T2D. However, despite its potential, only limited data are available on the use of quadruple OHAs [7,8]. Therefore, the present study investigated the effectiveness of quadruple OHAs in Korean patients with T2D.…”

Section: Introductionmentioning

confidence: 99%

Clinical Efficacy of Quadruple Oral Therapy for Type 2 Diabetes in Real-World Practice: A Retrospective Observational Study

et al. 2020

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Introduction: We aimed to evaluate the effectiveness of quadruple oral therapy in patients with inadequately controlled type 2 diabetes (T2D) with the use of three types of oral hypoglycemic agents. Methods: Medical records of 318 patients with T2D who were prescribed quadruple therapy in the Asan Medical Center were reviewed. Changes in glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels from baseline were assessed. The regimens of quadruple oral therapy included the following: (1) thiazolidinedione (TZD) add-on to metformin (MET) ? sulfonylurea (SU) ? dipeptidyl peptidase 4 inhibitor (DPP4i), (2) sodium-glucose cotransporter 2 inhibitor (SGLT2i) add-on to MET ? SU ? DPP4i, and (3) DPP4i add-on to MET ? SU ? TZD. Results: The TZD add-on significantly reduced HbA1c levels by 1.1% (from 9.0 ± 1.1 to 7.9 ± 1.1%, P \ 0.001) and FPG levels by 41.4 mg/dL (from 188.9 ± 45.9 to 147.4 ± 51.3 mg/dL, P \ 0.001). The SGLT2i add-on changed the mean HbA1c level from 8.9 ± 1.0 to 7.8 ± 1.0%, a reduction of 1.1% (P \ 0.001) and changed the mean FPG level from 193.4 ± 46.2 to 152.6 ± 37.0 mg/dL, a reduction of 40.8 mg/ dL (P \ 0.001). Finally, the DPP4i add-on reduced HbA1c levels by 1.3% (from 9.1 ± 1.3 to 7.8 ± 1.4%, P \ 0.001) and FPG levels by 39.3 mg/dL (from 190.7 ± 45.3 to 151.4 ± 41.6 mg/dL, P \ 0.001). Patients with higher baseline HbA1c levels (C 9.0%) showed a better response to quadruple therapy than those with baseline HbA1c levels lower than 9.0% for all three regimens. Conclusion: Quadruple oral hypoglycemic therapy can be a feasible option in patients with T2D.

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“…Despite the established efficacy of insulin, patients are not always willing to initiate and maintain strict adherence to the use of this treatment regimen [6][7][8]. The reluctance to initiate and adhere to insulin treatment by the patient and, in some cases, the prescribers may be attributed to an emerging phenomenon known as 'psychologic insulin resistance' (PIR) [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Psychometric Analysis Regarding the Barriers to Providing Effective Insulin Treatment in Type 2 Diabetic Patients

Lee

Jeon

et al. 2020

Diabetes Ther

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Introduction: A psychometric analysis on type 2 diabetic (T2D) patients was performed to assess whether glycated hemoglobin (HbA1c) levels were dependent upon either the psychologic or economic attitude toward the use of insulin as a treatment for their diabetic condition. Methods: A cross-sectional study was designed using 271 patients with T2D who regularly visited a tertiary referral hospital in South Korea from June 2019 to December 2019. Each patient enrolled in this protocol was treated with insulin for at least 6 months, had recordings of their plasma HbA1c measurement, and completed validated questionnaires consisting of items focusing on patient attitudes toward insulin use [Insulin Treatment Appraisal Scale (ITAS)] and cost-related issues related to diabetic supply purchase. Multiple regression analyses were performed to determine the association between their HbA1c and each item on the questionnaires. Results: In both males and females, there was a significant association (P \ 0.05) between HbA1c levels and multiple items on the ITAS questionnaire, which are generally regarded as a negative perception (ITAS 1 ''personal failure'' and ITAS 2 ''illness severity'' in males and ITAS 12 ''expected harm'' and ITAS 15 ''restrictiveness'' in females). In females, however, not all perceptions were negative, since one item (ITAS 8 ''anticipated effect'') was correlated with the measurement of a lower HbA1c level (-0.495 ± 0.211, P \ 0.05). There was no association between the levels of HbA1c and the cost of insulin or associated diabetic supplies. Since only a few patients in this study chose to reduce their drug dosing because of cost, the resistance to using insulin is likely not driven by economic reasons. Conclusion: The psychometric results of the ITAS suggested that HbA1c levels were directly associated with a positive attitude of the patient to willingly use insulin for therapy. The cost of the insulin therapy was not associated with HbA1c levels. These findings in the Korean population suggest that continued education is needed to ensure that T2D patients have a reinforced positive psychology toward the use of insulin in the control of their glycemia.

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Effectiveness and safety of empagliflozin‐based quadruple therapy compared with insulin glargine‐based therapy in patients with inadequately controlled type 2 diabetes: An observational study in clinical practice

Cited by 19 publications

References 13 publications

Efficacy and Safety of Sodium-Glucose Cotransporter-2 Inhibitors in Korean Patients with Type 2 Diabetes Mellitus in Real-World Clinical Practice

Efficacy and Safety of Sodium-Glucose Cotransporter-2 Inhibitors in Korean Patients with Type 2 Diabetes Mellitus in Real-World Clinical Practice

Clinical Efficacy of Quadruple Oral Therapy for Type 2 Diabetes in Real-World Practice: A Retrospective Observational Study

Psychometric Analysis Regarding the Barriers to Providing Effective Insulin Treatment in Type 2 Diabetic Patients

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