Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
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Comparative Effectiveness between Dipeptidylpeptidase-4 Inhibitors and Sulfonylureas in Combination with Metformin in Type 2 Diabetes Mellitus Patients

제2형 당뇨병 환자에서 Metformin/Dipeptidyl Peptidase-4 저해제 병용요법과 Metformin/Sulfonylurea 병용요법간의 효과에 대한 비교 연구

  • Park, Ji Hye (Division of Pharmaceutical Services, Asan Medical Center) ;
  • Park, Sunny (College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University) ;
  • Kim, Jae Youn (Division of Pharmaceutical Services, Asan Medical Center) ;
  • Kim, Joo Hee (College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University) ;
  • Gwak, Hye Sun (Graduate School of Clinical Health Sciences, Ewha Womans University)
  • 박지혜 (서울아산병원 약제팀) ;
  • 박선이 (이화여자대학교 약학대학) ;
  • 김재연 (서울아산병원 약제팀) ;
  • 김주희 (이화여자대학교 약학대학) ;
  • 곽혜선 (이화여자대학교 임상보건과학대학원)
  • Received : 2015.04.16
  • Accepted : 2015.05.01
  • Published : 2015.06.30
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Abstract

Objective: Treatment with sulfonylureas in combination with metformin improves glycemic control in type 2 diabetes mellitus (T2DM), but is associated with hypoglycemia and weight gain. This retrospective study aims to compare the effectiveness of dipeptidylpeptidase-4 (DPP-4) inhibitors and sulfonylureas as an add-on therapy to metformin in patients with T2DM. Methods: Data from medical records of 355 T2DM patients received therapy either DPP-4 inhibitors (DPP-4 inhibitor group) or sulfonylurea (SU group) in combination with metformin from 1 March 2009 to 30 September 2011 were retrospectively reviewed. Of total 355 patients, 231 patients were in DPP-4 inhibitor group and 124 patients were in SU group. Baseline Hemoglobin $A_{1c}$ ($HbA_{1c}$) level in SU group was higher than DPP-4 inhibitor group with a statistically significant difference (8.6% vs. 7.8%). Comparative analysis between DPP-4 inhibitor group and SU group was performed for $HbA_{1c}$ values, amounts of $HbA_{1c}$ changes, and rates of $HbA_{1c}$ changes from baseline at 6-month intervals and incidence rates of major cardiocerebral events. Results: SU group showed larger $HbA_{1c}$ changes in both amounts and rates compared to DPP-4 inhibitor group, although statistical significance was not found in all study periods. Proportions of patients with stable $HbA_{1c}$ <6.5% or 7% were significantly higher in DPP-4 inhibitor group than SU group (<6.5%: 30.4% vs. 13.4%, <7%: 72.3% vs. 41.2%). Time to achieve stable $HbA_{1c}$ <6.5% was not significantly different, but time to achieve stable $HbA_{1c}$ <7% was shorter in DPP4 inhibitor group than SU group with a significant difference. The incidence rate of cardiocerebral events in group of patients with or without previous events was 1.7%, not significantly lower than that in DPP-4 inhibitor group (4.0%). For newly encountered cardiocerebral events during the treatment, incidence rates of two groups did not differ significantly. Conclusion: DPP-4 inhibitors were as effective as sulfonylureas in achieving the $HbA_{1c}$ goal of less than 6.5% or 7% and cardiocerebral event rates did not differ between the two drugs.

Keywords

References

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