Antihyperglycemic agent therapy for adult patients with type 2 diabetes mellitus 2017: a position statement of the Korean Diabetes Association

Abstract

In 2017, the Korean Diabetes Association (KDA) published a position statement on the use of antihyperglycemic agents for patients with type 2 diabetes mellitus (T2DM). The KDA regularly updates its Clinical Practice Guidelines, but since the last update in 2015, many results from clinical trials have been introduced, and domestic data from studies performed in Korean patients with T2DM have been published. Recently, evidence from large clinical studies assessing cardiovascular outcomes following the use of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in patients with T2DM were incorporated into the recommendations. Additionally, new data from clinical trials using dipeptidyl peptidase 4 inhibitors and thiazolidinediones in Korean patients with T2DM were added. Following a systematic review and assessment of recent evidence, the KDA updated and modified its clinical practice recommendations regarding the use of antihyperglycemic agents and revised the treatment algorithm for Korean adult patients with T2DM.

Teneligliptin versus sitagliptin in Korean patients with type 2 diabetes inadequately controlled with metformin and glimepiride: A randomized, double‐blind, non‐inferiority trial

“…Neither teneligliptin nor sitagliptin significantly increased mean body weight; hence, neither appears to exacerbate the body weight gain often associated with sulfonylureas …”

“…Although international and local guidelines all recommend lifestyle management as the mainstay of treatment for T2DM, with metformin as the preferred initial oral antihyperglycaemic agent in most patients, there remains no consensus regarding which classes of agent(s) to add as dual and triple therapy, if and when required . DPP‐4 inhibitors are an important option in these cases, but few phase 3 studies have directly compared DPP‐4 inhibitors as add‐on therapy .…”

“…They work by increasing levels of active glucagon‐like peptide‐1 (GLP‐1), thereby promoting insulin secretion, in a blood glucose‐dependent manner, and hence decreasing glucose levels while minimizing the risk of hypoglycaemia . DPP‐4 inhibitors are recommended both in the guidelines of the Korean Diabetes Association and in international guidelines . Meta‐analyses have suggested that DPP‐4 inhibitors may be more potent in reducing HbA1c levels in Asian T2DM patients than in non‐Asian patients …”

“…Four of these studies were conducted in Asia; two were undertaken specifically in Korean patients. On the strength of these data, teneligliptin was included among the DPP‐4 inhibitors recommended in Korean guidelines for the treatment of T2DM …”

“…In patients with inadequate glycaemic control on metformin plus a sulfonylurea, DPP‐4 inhibitors are a rational add‐on for triple therapy. They have a neutral profile with regard to body weight gain and hypoglycaemia risk, and may help to minimize potential exacerbation by co‐administered sulfonylureas, which are associated with elevated risks of body weight gain and hypoglycaemia . Triple oral therapy that includes a DPP‐4 inhibitor has shown superior glycaemic control to dual therapy …”