- When initiating glargine (Lantus) in patients with type 2 diabetes (T2D) inadequately controlled with metformin and sitagliptin (Januvia), continuing the sitagliptin may result in better glycemic control without excess hypoglycemia.
Why this matters
- Clinical practice guidelines provide little guidance regarding continuing or discontinuing other glucose-lowering agents when initiating insulin therapy.
- 743 adults with inadequately controlled T2D (HbA1c ≥7.5%) on metformin and sitagliptin and initiating glargine were randomly assigned to continuing vs discontinuing sitagliptin for 30 weeks.
- Funding: Merck & Co., Inc., Kenilworth, NJ, USA.
- Mean HbA1c achieved and percentage point change from baseline were, respectively, 6.85% and −1.88% with sitagliptin vs 7.31% and −1.42% for placebo (P<.001>
- Percentages achieving HbA1c
- Documented symptomatic hypoglycemia (≤3.9 mmol/L [70 mg/dL]) occurred in 33.5% with sitagliptin vs 37.7% placebo (P=.250).
- Other adverse event rates and body weight changes were similar between the 2 groups.
- Use of other agents not investigated.