Impact of endogenous insulin secretion on the improvement of glucose variability in Japanese patients with type 2 diabetes treated with canagliflozin plus teneligliptin

Abstract

Aims/Introduction: To identify the effect of combination therapy with a dipeptidyl peptidase-4 inhibitor and a sodium-glucose cotransporter 2 inhibitor compared with switching from a dipeptidyl peptidase-4 inhibitor to a sodium-glucose cotransporter 2 inhibitor on improving the glucose variability in patients with or without impaired endogenous insulin secretion. Materials and Methods: A secondary analysis regarding the relationship between endogenous insulin secretion and the change in mean amplitude of glycemic excursions (DMAGE) was carried out in a multicenter, prospective, randomized, parallel-group comparison trial that enrolled patients with type 2 diabetes who had been taking teneligliptin and were treated by switching to canagliflozin (SWITCH) or adding canagliflozin (COMB). Participants were categorized into the following four subgroups: SWITCH or COMB and high or low fasting C-peptide (CPR) divided at baseline by the median. Results: DMAGE in the COMB group was greatly improved independent of a high or low CPR (-29.2 -28.3 vs -20.0 -24.6, respectively; P = 0.60). However, DMAGE was not ameliorated in the low CPR SWITCH group, and the DMAGE was significantly smaller than that in the high CPR COMB group (P < 0.01). Conclusions: COMB would be a better protocol rather than switching teneligliptin to canagliflozin to improve daily glucose variability in patients with impaired endogenous insulin secretion.

Switching from Insulin Degludec plus Dipeptidyl Peptidase-4 Inhibitor to Insulin Degludec/Liraglutide Improves Glycemic Variability in Patients with Type 2 Diabetes: A Preliminary Prospective Observation Study

“…Although glycated hemoglobin (HbA1c) is frequently used to evaluate glycemic control in clinical practice, it is now thought that stable glycemic control, with minimal GV, is also required for the prevention of diabetic cardiovascular complications in patients with type 2 diabetes (T2DM) [2]. Therefore, the importance of therapies associated with low GV has been advocated, and a number of studies have made use of continuous glucose monitoring (CGM) devices to assess this [3][4][5].…”