Effects on Clinical Outcomes of Adding Dipeptidyl Peptidase-4 Inhibitors Versus Sulfonylureas to Metformin Therapy in Patients With Type 2 Diabetes Mellitus

Ou, Shuo Ming; Shih, Chwen Ming; Chao, Pei Wen; Chu, Hee Ho; Kuo, Shu‐Chen; Lee, Yi Jung; Wang, Shuu Jiun; Yang, Chi‐Rei; Lin, Chih Ching; Chen, Tzeng Ji; Tarng, Der Cherng; Li, Szu Yuan; Chen, Yung Tai

doi:10.7326/m15-0308

Cited by 86 publications

(94 citation statements)

References 37 publications

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“…Comparable efficacy between gliptins and sulfonylureas when either is added to metformin has been proved in different meta-analyses 26–28. In terms of safety related to risk of hypoglycemia, cardiovascular events, and weight gain, gliptins score over sulfonylureas when used both as monotherapy or as add-on to ongoing metformin therapy 26,29. Most patients (53.61%) were on three or more antidiabetic drugs indicating that patients had had the disease for a significant duration.…”

Section: Discussionmentioning

confidence: 99%

Teneligliptin real-world efficacy assessment of type 2 diabetes mellitus patients in India (TREAT-INDIA study)

Ghosh¹,

Trivedi²,

Sanyal³

et al. 2016

DMSO

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Background and aimsTeneligliptin was introduced in India in May 2015. It has gained popularity and is already widely prescribed in type 2 diabetes mellitus (T2DM). This “real life” data collection was conducted to assess the efficacy of teneligliptin in Indian T2DM patients.MethodsPredesigned structured proforma was used to collect information from the prescribing physicians regarding the efficacy of teneligliptin when prescribed as monotherapy as well as combination therapy with other antidiabetic drugs in T2DM patients. Information on the glycemic parameters at baseline prior to starting teneligliptin and at the end of 3 months therapy was collected. The efficacy was assessed by analyzing the mean change in 3-month values of glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), and postprandial plasma glucose (PPG).ResultsData of 4305 patients was available for analysis. There was statistically significant improvement in mean HbA1c, FPG, and PPG with teneligliptin therapy. Means changes in HbA1c, FPG, and PPG were −1.37%±1.15%, 51.29±35.41 mg/dL, and 80.89±54.27 mg/dL, respectively. Subgroup analysis revealed that HbA1c (%) reduction with teneligliptin when used as monotherapy, add-on to metformin or add-on to metformin plus sulfonylureas combination, add-on to metformin plus alpha glucosidase inhibitor combination or add-on to insulin was 0.98±0.53, 1.07±0.83, 1.46±1.33, 1.43±0.80, and 1.55±1.05, respectively.ConclusionReal-world data suggests that teneligliptin significantly improves glycemic control in Indian patients with T2DM when prescribed either as monotherapy or as an add-on to one or more other commonly prescribed antidiabetic drugs.

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Section: Discussionmentioning

confidence: 99%

Teneligliptin real-world efficacy assessment of type 2 diabetes mellitus patients in India (TREAT-INDIA study)

Ghosh¹,

Trivedi²,

Sanyal³

et al. 2016

DMSO

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“…It is validated by the Taiwan National Health Research Institutes for research purposes [18]. This database represents most of the population of diabetic mellitus patients in Taiwan, with a sample of total 1,200,000 patients diagnosed with diabetes since 1999 [19]. It consists of deidentified secondary data for patient’s privacy protection.…”

Section: Methodsmentioning

confidence: 99%

Association between use of oral-antidiabetic drugs and the risk of aortic aneurysm: a nested case–control analysis

Hsu

Chen

et al. 2016

Cardiovasc Diabetol

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BackgroundPleiotropic effects on cardiovascular protection have been suggested in several oral antidiabetic drugs (OAD). The impacts of OADs on aortic aneurysm (AA) growth have been found in animal studies, but the evidence of their beneficial effects for AA protection in human are lacking. We investigated the relationship between OAD therapy and the risk of developing AA.MethodsWe conducted a nested case–control analysis using the database extracted from Taiwan’s National Health Insurance Research Database. The database consists of 1.2 million diabetic patients representing the majority of the type 2 diabetes population in Taiwan from 2000 to 2013. Cases were identified as those with either inpatient or outpatient diagnosis code of AA. One control was selected for each case matching on duration of follow-up, age, sex, urbanization, monthly income, severity of diabetes, and risk factor for AA. We identified variable classes of OADs, including metformin, sulfonylureas, thiazolidinedione (TZD), alpha-glucosidase inhibitors, meglitinide, dipeptidyl peptidase-4 (DPP-4) inhibitors prior to the development of AA.ResultsA total of 4468 cases diagnosed with AA and 4468 matched controls were identified. Metformin use, sulfonylurea use, and TZD were associated with lower risk of developing AA, odds ratio [OR] 0.72 (95 % confidence interval [CI] 0.64–0.80), 0.82 (95 % CI 0.74–0.92), and 0.82 (95 % CI 0.69–0.98), respectively. The effects of metformin and sulfonylurea on AA were dose responsive. Neither alpha-glucosidase inhibitors (OR 0.95; 95 % CI 0.81–1.11) nor DPP-4 inhibitors (OR 0.85; 95 % CI 0.68–1.07) was significantly associated with AA events.ConclusionsMetformin, sulfonylurea, and TZD treated patients were associated with lower risks of AA development, but not DPP-4 inhibitors or alpha-glucosidase inhibitor. The protective effects of hypoglycemic agents are further confirmed by the dose responsive relations in metformin and sulfonylurea groups.

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“…Although the addition of an SU is the most common step after metformin fails, these agents have been associated with hypoglycemia, sometimes requiring hospitalizations, particularly in the elderly [10] and in those with polypharmacy [57]. Observational cohort trials have also shown a disadvantage of SUs in general [58, 59], and when compared to DPP-4 inhibitors [60, 61]. …”

Section: Riskmentioning

confidence: 99%

Strategies for Diabetes Management: Using Newer Oral Combination Therapies Early in the Disease

Zonszein

Groop

2016

Diabetes Ther

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IntroductionThe duration of uncontrolled type 2 diabetes mellitus (T2DM) can adversely impact small and large vessels, eventually leading to microvascular and macrovascular complications. Failure of therapeutic lifestyle changes, monotherapy, and clinical inertia contribute to persistent hyperglycemia and disease progression. The aim was to review the complex pathophysiology of type 2 diabetes and how different oral agents can be used effectively as first-line therapy in combination with metformin, as well as in patients not achieving glycemic goals with metformin therapy.MethodsFor this review, a non-systematic literature search of PubMed, NCBI, and Google Scholar was conducted.ResultsNew oral agents have made it possible to improve glycemic control to near-normal levels with a low risk of hypoglycemia and without weight gain, and sometimes with weight loss. Early combination therapy is effective and has been shown to have a favorable legacy effect. A number of agents are available in a single-pill combination (SPC) that provides fewer pills and better adherence. Compared with adding a sulfonylurea, still the most common oral combination used, empagliflozin has been shown to decrease cardiovascular (CV) events in a dedicated CV outcome study, and pioglitazone has been effective in reducing the risk of secondary CV endpoints, whereas sulfonylureas have been associated with an increased risk of CV disease. In those failing metformin, triple oral therapy by adding a non-metformin SPC such as empagliflozin/linagliptin or pioglitazone/alogliptin is a good option for reducing glycated hemoglobin (HbA1c) without significant hypoglycemia.ConclusionClinicians have a comprehensive armamentarium of medications to treat patients with T2DM. Clinical evidence has shown that dual or triple oral combination therapy is effective for glycemic control, and early treatment is effective in getting patients to goal more quickly. Use of SPCs is an option for double or triple oral combination therapy and may result in better adherence.

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Effects on Clinical Outcomes of Adding Dipeptidyl Peptidase-4 Inhibitors Versus Sulfonylureas to Metformin Therapy in Patients With Type 2 Diabetes Mellitus

Abstract: None.

Cited by 86 publications

References 37 publications

Teneligliptin real-world efficacy assessment of type 2 diabetes mellitus patients in India (TREAT-INDIA study)

Teneligliptin real-world efficacy assessment of type 2 diabetes mellitus patients in India (TREAT-INDIA study)

Association between use of oral-antidiabetic drugs and the risk of aortic aneurysm: a nested case–control analysis

Strategies for Diabetes Management: Using Newer Oral Combination Therapies Early in the Disease

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