Analysis of the effectiveness of second oral glucose-lowering therapy in routine clinical practice from the mediterranean area: A retrospective cohort study. (January 2021)

• Record Type: Journal Article
• Authors: Vlacho, Bogdan; Mundet-Tudurí, Xavier; Mata-Cases, Manel; Vallès-Callol, Joan Antoni; Real, Jordi; Farré, Magí; Cos, Francesc Xavier; Khunti, Kamlesh; Mauricio, Dídac; Franch-Nadal, Josep
• Is Part Of: Diabetes research and clinical practice. Volume 171(2021)
• Publication Date: 2021-01
• Subjects: DPP-IV inhibitor -- Glycaemic control -- SGLT2 inhibitor -- Sulphonylureas -- Type 2 diabetes -- Weight control; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2020.108616
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: Addition of a SGLT-2i to metformin was associated with greater weight reduction. Addition of a SGLT-2i to metformin is associated with HbA1c and weight reduction. HbA1c reduction was similar after addition of SGLT-2i, DPP4i or SU to metformin. The treatment intensification in our primary care settings is far from optimal. Abstract: Aim: To compare the changes in HbA1c, the effect on body weight or both combined after the addition of a DPP-4i, SGLT-2i, or sulfonylureas (SU) to metformin in real-world condition. Methods: We used a primary care SIDIAP database. The included subjects were matched by propensity score according to baseline age, sex, HbA1c, weight, inclusion date, diabetes duration, and kidney function. Results: Mean absolute HbA1c reduction was: 1.28% for DPP4i, 1.29% for SGLT2i and 1.26% for SU. Mean weight reduction was: 1.21 kg for DPP4i, 3.47 kg for SGLT2i and 0.04 kg for SU. The proportion of patients who achieved combined target HbA1c (≥0.5%) and weight (≥3%) reductions after the addition of DPP-4i, SGLT-2i or SU, was: 24.2%, 41.3%, and 15.2%, respectively. Small differences in systolic blood pressure reduction (1.07, 3.10 and 0.96 mmHg, respectively) were observed in favour of SGLT-2i. Concerning the lipids, we observed small differences, with an HDL-cholesterol increase with SGLT-2i. Conclusion: Our real-world study showed that the addition of SGLT-2i to metformin was associated with greater reductions in weight and the combination target of weight-HbA1c compared to SU and DPP4 inhibitors. However, similar hypoglycaemic effectiveness was observed among the three-drug classes.