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Clinical Summary

T2DM: second line therapies initiated after metformin improve glycaemic control

Takeaway

  • In patients with type 2 diabetes mellitus (T2DM), all second-line therapies initiated after metformin monotherapy improved glycaemic control with greatest reduction in HbA1c levels.
  • A significant weight loss and higher treatment persistence rates were observed in patients with metformin plus sodium–glucose cotransporter-2 (SGLT-2) inhibitor or dipeptidyl peptidase-4 (DPP-4) inhibitor.

Why this matters

  • Current guidelines recommend metformin as the first-line therapy in patients with T2DM.
  • Majority of patients with T2DM require treatment intensification from metformin monotherapy to maintain recommended HbA1c target.

Study design

  • Retrospective study included 9097 patients with T2DM from the UK clinical practice databases who received first-line metformin monotherapy and initiated second-line therapy.
  • Treatment persistence and changes in HbA1c levels and weight were assessed at 6-month interval up to 18 months.
  • Funding: AstraZeneca.

Results

  • At 18 months, the cumulative proportion of patients changing treatment was lower in patients on metformin plus SGLT-2 inhibitor (42.3%), followed by patients on metformin plus either sulphonylureas or DPP-4 inhibitor (46.8%).
  • Overall, reduction in mean HbA1c levels was seen with all second-line therapies (−1.23%; standard error [SE], 0.05/−13.4 mmol/mol (SE, 0.5).
  • Compared with baseline, there was a significant weight reduction in patients treated with metformin plus either SGLT-2 inhibitor or DPP-4 inhibitor (P<.001).
  • Reduction in HbA1c level ≥0.5%, body weight ≥2.0 kg and treatment persistence at 18 months was higher in patients (36.5%) who received metformin plus an SGLT-2 inhibitor compared to other therapies.

Limitations

  • Data on treatment discontinuation or intensification were removed.
  • Patients with only first-line metformin monotherapy were included.

References


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