Harmful versus beneficial effects of using short-term combined oral antidiabetic therapy: ‎An open label comparative clinical trial ‎

Abstract

Background. Although oral antidiabetic drugs have many beneficial pleiotropic effects, they are not free from adverse reactions which may interfere with glucose homeostasis. This study aimed to assess the effects of oral antidiabetic drugs as add-on-therapy to metformin, on the metabolic, cardiac and renal determinants. Material and methods. A total number of seventy-eight type 2 diabetes (T2D) patients who were treated with metformin were allocated to add-on-therapy for 12 weeks, with glimepiride (4 mg/day, n = 26), sitagliptin (100 mg/day, n = 28), and canagliflozin (300 mg/day, n = 24). Anthropometric measurements, glycemic indices, and lipid and renal markers, were determined before and after the treatment. Results. All of the three treatments significantly decreased the glycemic indices, triglyceride-to-glucose index, and non-significantly altered the serum uric acidto creatinine ratio. Glimepiride significantly increased the waist-to-height ratio (0.630 ± 0.057 vs. 0.640 ± 0.057, P = 0.040), while sitaglipitin and canagliflozin significantly decreased it (0.650 ± 0.058 versus 0.640 ± 0.054, p = 0.009, and 0.650 ± 0.041 versus 0.630 ± 0.044, P < 0.001). Estimated glomerular filtration rate calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (mL/min/1.73 m 2 ) sig-nificantly declined in patients using glimepiride (109.0 ± 10.4 vs. 103.6 ± 10.9, P = 0.001), and sitagliptin (106.1 ± 12.4 vs. 103.3 ± 15.0, P = 0.013). Conclusion. Careful selection oral antidiabetic agents can protect T2D patients from harmful events, particularly those related to cardiovascular events and renal function. (Clin Diabetol 2021; 10