Four-Year Durability of Initial Combination Therapy with Sitagliptin and Metformin in Patients with Type 2 Diabetes in Clinical Practice; COSMIC Study

Abstract

ObjectivesWe investigated the efficacy of initial combination therapy with sitagliptin and metformin in patients with type 2 diabetes for 4 years in clinical practice.MethodsBetween 2009 and 2010, we reviewed 1,178 patients with type 2 diabetes (HbA1c ≥7.5% or 58 mmol/mol) prescribed initial combination therapy with sitagliptin and metformin. After excluding 288 patients without a second follow-up, 890 individuals (age, 58.0 ± 12.5 years; BMI, 25.4 ± 3.5 kg/m2; HbA1c, 8.6 ± 1.1%) were followed up with every 3–6 months for 4 years. Homeostasis model assessments for insulin resistance and β-cell function (HOMA-β) were recorded at baseline. The response criterion was HbA1c reduction by ≥0.8% from baseline or attainment of the target HbA1c (≤7.0% or 53 mmol/mol). At the end of every year of treatment, changes in HbA1c from the baseline were assessed.ResultsAfter 1 year, 72.2% of patients with initial combination therapy had responded, defined as HbA1c reduction ≥0.8% or attainment of the target HbA1c ≤7.0%. After 4 years, 35.4% of the patients still showed a response, with an HbA1c level of 7.0 ± 0.9%. A high HbA1c level at baseline was the most significant independent predictor of the long-term response (P<0.001). In addition, low HOMA-β was a significant predictor of a greater reduction in HbA1c. This treatment was generally well tolerated over the 4-year follow-up period, without any serious adverse events.ConclusionsThis real-world follow-up study shows a persistent glucose-reducing effect of initial combination therapy with sitagliptin and metformin for up to 4 years.

Effects of metformin and alogliptin on body composition in people with type 2 diabetes

“…C-peptide immunoreactivity was not associated with a reduction in FPG and HbA1c in both the metformin and alogliptin groups in the present study. This finding is in contrast to that of a recent clinical trial in which low baseline b-cell function was an independent predictor of a good response in participants undergoing combination therapy with sitagliptin and metformin 32 . The administration of x-3 polyunsaturated fatty acids has been reported to induce GLP-1 secretion in mice 33,34 .…”

Combination Glucose-Lowering Therapy Plans in T2DM: Case-Based Considerations

“…Not surprisingly, results from several studies have shown that initial combination therapy with metformin and a DPP-4 inhibitor provides greater improvement in glycemic control than monotherapy with either agent [14,[18][19][20]. For example, results from a 24-week study with linagliptin plus metformin demonstrated greater placebo-corrected reductions in HbA1c with initial combination therapy than monotherapy with either component: -1.7% for linagliptin 5 mg/metformin 2000 mg, -1.3% for linagliptin 5 mg/metformin 1000 mg, -1.2% for metformin 2000 mg, -0.8% for metformin 1000 mg, and -0.6% for linagliptin 5 mg (all p \ 0.0001) [18].…”

A Hospital-Based Prospective Cohort Study of Aged People to Elucidate the Predictive Factors for Chronic Disease and Mortality: HAPPY Cohort

“…An XE-2100 Hematology Analyzer is used for measuring the white blood cell count, hemoglobin level, hematocrit, and platelet count. Aspartate and alanine aminotransferase (NADH-UV method), total bilirubin (bilirubin oxidase method), thyroid function test (electrochemiluminescence immunoassay), blood urea nitrogen (urease/GLDH method), creatinine (Jaffe's kinetic method), calcium (OC/PC method), and phosphorus (Molybdate reduction method) are measured at the central laboratory of SNUBH, as reported previously 32,33) . The biochemical tests are done immediately after sample collection.…”