Glycemic Improvement with a Fixed‐dose combination of DPP‐4 inhibitor + metformin in patients with Type 2 diabetes (GIFT study)

Abstract

This study investigates changes in A1C following a switch from dual therapy of metformin and DPP-4 inhibitor to a fixed-dose combination (FDC) of metformin + DPP-4 inhibitor following the introduction of the FDC in the provincial formulary. The LMC Diabetes Registry was queried retrospectively for patients with type 2 diabetes, aged between 18 and 80 years with at least one A1C recorded prior and ≥3 months post-switch. Five hundred and sixty-eight subjects with mean age 64 ± 12 years and mean A1C 7.7% ± 1.2% met study criteria. Overall, A1C was 0.3% lower post-switch to FDC (P < .01). In stratified analysis, subjects with baseline A1C between 7% and 10% had 0.4% lower A1C (P < .01), with 31% of these subjects reaching target A1C ≤7%, post-switch. A1C reduction was greater among patients with a higher baseline pill burden: 0.4% among those using ≥10 pills/day vs. 0.1% for those with <10 pills/day (P = .02). In this real-world study, switching to FDC of metformin + DPP-4 inhibitor was associated with a significant improvement in A1C. Switching to FDC, especially in patients with high pill burden, can improve A1C goal achievement in clinical practice.

Time trends in diabetes medication prescription and factors associated with metformin discontinuation in people with newly diagnosed type 2 diabetes: A national population‐based study

“…Metformin/ DPP-4i combinations became predominant over time, at the expense of metformin/sulfonylurea combinations, which can be partly explained by the marketing of metformin/DPP-4i fixed combinations, facilitating the prescription of this combination. 16 Similar findings were reported in the United Kingdom between 2010 and 2017, 7 while metformin-sulfonylurea combinations remained the leading form of dual therapy in the United States, 8 probably because of the lower cost of sulfonylureas.…”

Lack of Treatment Persistence and Treatment Nonadherence as Barriers to Glycaemic Control in Patients with Type 2 Diabetes

“…Several approaches to improving treatment persistence and adherence have been suggested, including: reducing treatment complexity (e.g. using fixed-dose combination therapy that decreases the frequency of administration [ 24 , 35 ], implantable therapies for drug delivery); developing medications with an improved safety profile (e.g. lower risk of weight gain, hypoglycaemia, gastrointestinal side effects [ 20 , 35 ]); enhancing educational initiatives; and improving communication (e.g.…”

“…Among patients with T2D who initiate a fixed-dose combination of DPP-4 inhibitor plus metformin following switch from dual therapy, the resulting improvements in glycaemic control and/or reductions in gastrointestinal side effects are speculated as being related to improved adherence post-switch [ 23 , 24 ]. Other factors associated with adherence to oral medications include family support among children and adolescents with T2D [ 25 ], and self-efficacy and perceptions of illness among adults with T2D [ 26 ].…”

Triple fixed-dose combination empagliflozin, linagliptin, and metformin for patients with type 2 diabetes

“…Since the management of T2D frequently requires combination therapy, the use of FDC therapy can reduce the pill burden leading to a simplified treatment regimen, reduce medication costs to patients, and improve adherence to therapy [14,17,18]. This can translate into clinical benefits resulting from improved patient satisfaction and compliance with FDC therapy, leading to improved glycemic control and an increased likelihood of achieving glycemic targets [19][20][21]. FDCs are increasingly used in clinical practice for a range of chronic disorders that require the use of multiple treatments, such as chronic obstructive pulmonary disease [22], hypertension [23,24], hepatitis C [25,26], and HIV infection [27,28], with the aim of simplifying treatment regimens and improving clinical outcomes.…”