A comparison of effects of DPP-4 inhibitor and SGLT2 inhibitor on lipid profile in patients with type 2 diabetes

Abstract

BackgroundPrevious studies suggest that dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium glucose cotransporter 2 (SGLT2) inhibitors have different effects on the lipid profile in patients with type 2 diabetes. We investigated the effects of DPP-4 inhibitors and SGLT2 inhibitors on the lipid profile in patients with type 2 diabetes.MethodsFrom January 2013 to December 2015, a total of 228 patients with type 2 diabetes who were receiving a DPP-4 inhibitor or SGLT2 inhibitor as add-on therapy to metformin and/or a sulfonylurea were consecutively enrolled. We compared the effects of DPP-4 inhibitors and SGLT2 inhibitors on the lipid profile at baseline and after 24 weeks of treatment. To compare lipid parameters between the two groups, we used the analysis of covariance (ANCOVA).ResultsA total of 184 patients completed follow-up (mean age: 53.1 ± 6.9 years, mean duration of diabetes: 7.1 ± 5.7 years). From baseline to 24 weeks, HDL-cholesterol (HDL-C) levels were increased by 0.5 (95% CI, −0.9 to 2.0) mg/dl with a DPP-4 inhibitor and by 5.1 (95% CI, 3.0 to 7.1) mg/dl with an SGLT2 inhibitor (p = 0.001). LDL-cholesterol (LDL-C) levels were reduced by 8.4 (95% CI, −14.0 to -2.8) mg/dl with a DPP-4 inhibitor, but increased by 1.3 (95% CI, −5.1 to 7.6) mg/dl with an SGLT2 inhibitor (p = 0.046). There was no significant difference in the mean hemoglobin A1c (8.3 ± 1.1 vs. 8.0 ± 0.9%, p = 0.110) and in the change of total cholesterol (TC) (p = 0.836), triglyceride (TG) (p = 0.867), apolipoprotein A (p = 0.726), apolipoprotein B (p = 0.660), and lipoprotein (a) (p = 0.991) between the DPP-4 inhibitor and the SGLT2 inhibitor.ConclusionsThe SGLT2 inhibitor was associated with a significant increase in HDL-C and LDL-C after 24 weeks of SGLT2 inhibitor treatment in patients with type 2 diabetes compared with those with DPP-4 inhibitor treatment in this study.Trial registrationThis study was conducted by retrospective medical record review.Electronic supplementary materialThe online version of this article (doi:10.1186/s12944-017-0443-4) contains supplementary material, which is available to authorized users.

Sodium‐glucose co‐transporter‐2 inhibitors, the latest residents on the block: Impact on glycaemic control at a general practice level in England

“…Previously, we showed through cross‐sectional analysis, which we confirmed in this paper, that moving levels of local service performance and prescribing of metformin and sulphonylureas from the median to the 90th percentile level might be associated with 2 10 000 additional patients achieving TGC and 62 000 fewer at HGR. The associations between change in SGLT2 inhibitor and DPP‐4 inhibitor prescription at a practice level and the proportions of patients achieving TGC and at HGR may be important, if the link is causative . Improving glucose control by using new drugs would be costly, although the present findings suggest, for example, that an investment of £50 m in additional SGLT2 inhibitors in those practices prescribing around or below the national average level would include an additional 1 00 000 patients and could bring as many as 12 500 patients out of HGR and 20 000 into TGC.…”

Impact of Glucose-Lowering Medications on Cardiovascular and Metabolic Risk in Type 2 Diabetes

“…Two other placebo-controlled studies of dapagliflozin (10 mg) for a duration of 12 [45] and 24 weeks [46] revealed the ability of this drug to significantly reduce small dense LDL-C (p < 0.005 vs. sitagliptin and p < 0.003 for intergroup comparison) but not the less atherogenic large LDL-C (p < 0.026 vs. sitagliptin, p < 0.671 for intergroup comparison). Interestingly, HDL-2-C (a well-known marker inversely associated with triglyceride levels and insulin resistance) was found to be significantly increased (p < 0.001 vs sitagliptin; p < 0.013 for intergroup comparison) [45].…”

“…Interestingly, further studies comparing linagliptin and gemigliptin vs. dapagliflozin (oriented to add-on therapy to metformin and/or sulfonylurea for 24-weeks) demonstrated a significant increase in HDL-C levels in subjects treated with SGLT-2is [46].…”

DIAGNOSIS OF ENDOCRINE DISEASE: Drug-induced endocrinopathies and diabetes: a combo-endocrinology overview

“…One explanation could be that these drugs cause a switch from carbohydrate to lipid utilization, thereby increasing hepatic fatty acids levels to induce ketone and hepatic TC production. Empagliflozin was also associated to a lower LDL receptor expression and LDLc catabolism (198). Drug-induced effects on serum lipid levels and CV risk are summarized in Table 8.…”