Combination Therapy of Oral Hypoglycemic Agents in Patients with Type 2 Diabetes Mellitus

Moon, Min Kyong; Hur, Kyu Yeon; Ko, Seung Hyun; Park, Seok O; Lee, Byung Wan; Kim, Jin Hwa; Rhee, Sang Youl; Kim, Hyun Jin; Choi, Kyung Mook; Kim, Nan Hee

doi:10.4093/dmj.2017.41.5.357

Cited by 26 publications

(22 citation statements)

References 44 publications

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“…This is attributed to the higher baseline weight in this group and higher HbA1c patients enrolled in this group. Glycemic control and improved lipid profile was observed similar to studies of by Hermansen et al [22] and M K Moon et al [23] Insulin resistance (HOMA-IR) was found to be decreased (p value < 0.001) and beta cell function (HOMA-β) was improved significantly with mean difference of 9. In all the four groups, improvement in HOMA-IR and HOMA-β were significant (p value < 0.05).…”

Section: Discussionsupporting

confidence: 86%

Effect of Lifestyle Modification and Oral Anti-Diabetic Drugs on Metabolic Parameters in Recently Diagnosed Patientswith Uncomplicated Type 2 Diabetes Mellitus in Eastern India

Pradhan¹,

Das²,

Parhi³

et al. 2018

JDM

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BACKGROUND: Oral anti-diabetic drugs (OADs) are often advised for initial treatment for patients with Type 2 Diabetes Mellitus (T2DM). Their effects on glycemic control, lipid profile, insulin resistance and beta cell function has not been systematically studied in India. The objective of this study was to evaluate the effect of lifestyle modification and OADs on metabolic parameters in recently diagnosed uncomplicated T2DM patients. MATERIAL METHODS: A total of consecutive sixty four (64) cases of recently diagnosed uncomplicated T2DM in the age group of 30 -60 years were studied. They were evaluated for weight, body mass index (BMI), fasting plasma glucose (FPG), 2hr post glucose plasma glucose (2hrPGPG), HbA1c, lipid profile, serum fasting insulin, c-peptide, HOMA-IR and HOMA-β. They were divided into four groups according to increasing order of HbA1c values (6.5% -6.9%, 7% -7.5%, 7.6% -8.5%, 8.6% -8.9%). These four groups were subjected to lifestyle modification (LSM), monotherapy with metformin (1 g) and LSM, dual drug therapy i.e. metformin (1 g), glimepiride (1 mg) and LSM, triple drug therapy i.e. metformin (1 g), glimepiride 1 mg, sitagliptin 100 mg) and LSM respectively. These patients were followed up after three months of therapy. They were evaluated for the same metabolic parameters and compared with their baseline value. Fourteen (14) patients were lost to follow up. RESULTS: We found 91%, 92.8%, 53.3% and 60% of our patients from above four different groups achieved target glycemic control (HbA1c ≤ 6.5%). In all

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Section: Discussionsupporting

confidence: 86%

Effect of Lifestyle Modification and Oral Anti-Diabetic Drugs on Metabolic Parameters in Recently Diagnosed Patientswith Uncomplicated Type 2 Diabetes Mellitus in Eastern India

Pradhan¹,

Das²,

Parhi³

et al. 2018

JDM

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“…A common limitation of the aforementioned studies was an insufficient number of PaC cases due to its low incidence rate 9 , 20 , 21 . Although DPP4i has favorable safety profiles, such as a low risk of hypoglycemia or weight gain, and effectiveness in glycemic control, the high price is a stumbling block for its usage 16 , 22 . In Korea, however, the use of DPP4i has dramatically increased since 2009, and comprised one-third of the market share in 2013 because of the approval for reimbursement, with metformin dominating the market over this period 11 , 12 .…”

Section: Discussionmentioning

confidence: 99%

“…A preclinical study suggested that the antitumor effect of DPP4i is due to downregulation of autophagy, increased apoptosis, and cell cycle arrest 23 . Given that DPP4i has been widely used as a second-line therapy after metformin 16 , 22 , most DPP4i users were also metformin users. To avoid overestimating the protective effect of DPP4i by a possible combined metformin antitumor effect, we repeated the analyses confined to metformin users.…”

Section: Discussionmentioning

confidence: 99%

The influence of diabetes and antidiabetic medications on the risk of pancreatic cancer: a nationwide population-based study in Korea

Lee

Park

et al. 2018

Sci Rep

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This study investigated the effects of diabetes and antidiabetic medications on the risk of pancreatic cancer(PaC). We extracted data on Koreans with newly diagnosed diabetes and selected age- and sex-matched controls provided by the National Health Insurance Corporation. Incident PaC was defined as a new registration in the Korea Central Cancer Registry under ICD-10 C25 with admission history until 2015. During 19,429,617.1 person-years, 8,589 PaCs were identified in 1,005,409 subjects for diabetes group and 4,021,636 subjects for control group. The diabetes group showed more than a two-fold risk for PaC compared with the control group. Among antidiabetic medications, metformin, thiazolidinedione, and dipeptidyl peptidase-4 inhibitor exposure was associated with decreased risk for future PaC(hazard ratio[95% confidence interval] = 0.86[0.77–0.96], 0.82[0.68–0.98], 0.57[0.51–0.64], respectively), whereas sulfonylurea and insulin exposure was related to increased risk(hazard ratio[95% CI] = 1.73[1.57–1.91], 2.86[1.43–5.74], respectively) compared to subjects with no drug exposure. Moreover, subjects with dual exposure history to metformin plus thiazolidinedione or metformin plus dipeptidyl peptidase-4 inhibitor had a lower risk of PaC compared to metformin-only treated subjects. In conclusion, Korean adults with diabetes are at higher risk of PaC compared with nondiabetic individuals, and this risk may be modified by antidiabetic medications.

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“…In conclusion, as recent guidelines have stipulated, selection of a third agent as add‐on therapy to metformin and sulfonylurea should be based on the individual patient's clinical characteristics as well as on efficacy, side effects, mechanism of action, risk of hypoglycaemia, effect on body weight, patient preference, and combined comorbidity . In this setting, the first‐ever direct, head‐to‐head, comparative clinical trial of two DPP‐4 inhibitors, teneligliptin and sitagliptin, in an Asian T2DM population who were not controlled with dual metformin/sulfonylurea combination therapy, clearly showed that teneligliptin 20 mg met the primary endpoint of showing non‐inferiority to sitagliptin 100 mg.…”

Section: Discussionmentioning

confidence: 99%

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

Kim

Kang

Jang

et al. 2018

Diabetes Obesity Metabolism

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Aim To assess the efficacy and safety of add‐on therapy with the dipeptidyl peptidase‐4 inhibitor teneligliptin compared with sitagliptin in patients with type 2 diabetes (T2DM) inadequately controlled with metformin and glimepiride. Materials and Methods This was a phase 3, randomized, double‐blind, non‐inferiority study of adult Korean subjects with T2DM (n = 201), with HbA1c ranging from 7.0% to 11.0%, on stable doses of metformin plus glimepiride. Subjects were randomized in a 1:1 fashion to receive either oral teneligliptin 20 mg or sitagliptin 100 mg for 24 weeks. The primary endpoint was change from baseline in HbA1c. Results At baseline, mean age was 60.56 ± 9.41 years, body mass index was 25.23 ± 2.85 kg/m 2 and HbA1c was 8.11% ± 0.79%. At 24 weeks, both groups achieved significant reductions from baseline in HbA1c (teneligliptin, −1.03% ± 0.10% [ P < 0.0001]; sitagliptin, −1.02% ± 0.10% [ P < 0.0001]). The inter‐group difference was −0.01% (95% confidence interval [CI]: −0.28, 0.26; P = 0.9497); the upper limit of the 95% CI was within the preset limit for non‐inferiority (0.4%). There were no significant differences between groups in the proportion of patients achieving HbA1c targets, or changes from baseline in fasting plasma glucose, body weight or lipid levels at 24 weeks. Rates of adverse events (teneligliptin, n = 63 [61.76%]; sitagliptin, n = 61 [62.24%]; P = 0.9442) and hypoglycaemia (teneligliptin, n = 32 [31.37%]; sitagliptin, n = 28 [28.57%]; P = 0.6656) were similar. Conclusion Teneligliptin was non‐inferior to sitagliptin in the context of triple therapy for T2DM and is an important option in this setting.

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Combination Therapy of Oral Hypoglycemic Agents in Patients with Type 2 Diabetes Mellitus

Cited by 26 publications

References 44 publications

Effect of Lifestyle Modification and Oral Anti-Diabetic Drugs on Metabolic Parameters in Recently Diagnosed Patientswith Uncomplicated Type 2 Diabetes Mellitus in Eastern India

Effect of Lifestyle Modification and Oral Anti-Diabetic Drugs on Metabolic Parameters in Recently Diagnosed Patientswith Uncomplicated Type 2 Diabetes Mellitus in Eastern India

The influence of diabetes and antidiabetic medications on the risk of pancreatic cancer: a nationwide population-based study in Korea

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

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