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Sodium Glucose Cotransporter-2 Inhibitors as an Add-on Therapy to Metformin Plus Dipeptidyl Peptidase-4 Inhibitor in Patients with Type 2 Diabetes

 Jaehyun Bae  ;  Young-Eun Kim  ;  Minyoung Lee  ;  Yong-Ho Lee  ;  Byung-Wan Lee  ;  Bong-Soo Cha  ;  Eun Seok Kang 
 YONSEI MEDICAL JOURNAL, Vol.63(6) : 539-544, 2022-06 
Journal Title
Issue Date
Diabetes Mellitus, Type 2* / drug therapy ; Dipeptidyl-Peptidase IV Inhibitors* / therapeutic use ; Dipeptidyl-Peptidases and Tripeptidyl-Peptidases / therapeutic use ; Glycated Hemoglobin A / analysis ; Humans ; Hypoglycemic Agents / therapeutic use ; Metformin* / therapeutic use ; Retrospective Studies ; Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use
Type 2 diabetes mellitus ; glycemic control ; sodium-glucose cotransporter 2 inhibitors.
Purpose: To date, no study has compared the effects of adding sodium glucose cotransporter-2 (SGLT-2) inhibitors to the combination of metformin plus dipeptidyl peptidase-4 (DPP-4) inhibitors to the effects of adding other conventional anti-diabetic drugs (ADDs) to the dual therapy. We aimed to compare the effect of adding SGLT-2 inhibitors with that of adding sulfonylurea (SU) in type 2 diabetes (T2D) patients inadequately controlled with metformin plus DPP-4 inhibitors.

Materials and methods: This study was designed to evaluate the non-inferiority of SGLT-2 inhibitor to SU as an add-on therapy to the dual combination of metformin plus DPP-4 inhibitors. A total of 292 T2D patients who started SU or SGLT-2 inhibitors as an add-on therapy to metformin plus DPP-4 inhibitors due to uncontrolled hyperglycemia, defined as glycated hemoglobin (HbA1c) ≥7%, were recruited. After propensity score matching, 90 pairs of patients remained, and 12-week changes in HbA1c levels were reviewed to assess glycemic effectiveness. Data from these patients were analyzed retrospectively.

Results: After 12 weeks of triple therapy, both groups showed significant changes in HbA1c levels, with a mean of -0.9% in each group. The inter-group difference was 0.01% [95% confidence interval (CI): -0.26-0.27], and the upper limit of the 95% CI was within the limit for non-inferiority (0.40%). There were no inter-group differences in the changes of liver enzyme levels and kidney function.

Conclusion: Adding SGLT-2 inhibitors is not inferior to adding SU as a third-line ADD to metformin plus DPP-4 inhibitor combination therapy.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Eun Seok(강은석) ORCID logo https://orcid.org/0000-0002-0364-4675
Kim, Young-Eun(김영은)
Bae, Jae Hyun(배재현) ORCID logo https://orcid.org/0000-0002-3462-890X
Lee, Minyoung(이민영) ORCID logo https://orcid.org/0000-0002-9333-7512
Lee, Byung Wan(이병완) ORCID logo https://orcid.org/0000-0002-9899-4992
Lee, Yong Ho(이용호) ORCID logo https://orcid.org/0000-0002-6219-4942
Cha, Bong Soo(차봉수) ORCID logo https://orcid.org/0000-0003-0542-2854
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