제2형 당뇨병 환자에서 Metformin과 병용한 Sodium-Glucose Cotransporter 2 Inhibitors와 Dipeptidyl Peptidase 4 Inhibitors의 효능 비교
Comparisons of Efficacy Between Sodium-Glucose Cotransporter 2 Inhibitors and Dipeptidyl Peptidase 4 Inhibitors Add-on to Metformin Therapy in Type 2 Diabetes Mellitus Patients
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Background : Type 2 diabetes has a high risk of complications such as cardiovascular and chronic kidney disease. In Korea, the combination therapy of the metformin and dipeptidyl peptidase 4 (DPP4) inhibitors is preferred to the sodium-glucose cotransporter 2 (SGLT2) inhibitors. The American Diabetes Association (ADA) has stated that the SGLT2 inhibitors can be used in combination with the metformin in parallel with the DPP4 inhibitors. But, there is a lack of direct comparative studies of the SGLT2 inhibitors and the DPP4 inhibitors in Korea. The purpose of this study was to compare the efficacy of the SGLT2 and the DPP4 inhibitors add-on to metformin therapy. Methods : This was a retrospective study conducted June 2018-May 2019. This study investigated the medical records of patients administered with metformin and SGLT2 or DPP4 inhibitors. Results : Of the total of 155 patients, 46 were administered with the metformin and the SGLT2 inhibitors (SGLT2-I group) and the remaining patients were administered with the DPP4 inhibitors (DPP4-I group). There was no significant difference in the average change in HbA1c and fasting blood sugar (FBS) in both groups (p=0.102, p=0.512). However, the average change in body weight decreased by 8.7±17.7 kg in the SGLT2-I group and increased by 0.3±3.9 kg in the DPP4-I group (P<0.001). The average change in the mean arterial pressure (MAP) decreased by 6.6±8.0 mmHg in the SGLT2-I group and 0.2±13.3 mmHg in the DPP4-I group (p=0.001). The average creatinine clearance (CrCl) change increased by 5.5±24.3 mL/min in the SGLT2-I group and 0.4±10.3 mL/min in the DPP4-I group (P=0.001). There was no significant difference in the incidence of hypoglycemia and urinary tract infections between the two groups (p=0.507, p=0.079, respectively). Conclusion : In summary, the SGLT2-I group was more effective in reducing body weight and the MAP and improving the CrCl than the DPP4-I group. So, we suggest that the SGLT2 inhibitors may be considered as the first choice in combination with the metformin in patients with a high risk of diabetic complications.
Abstract
Background : Type 2 diabetes has a high risk of complications such as cardiovascular and chronic kidney disease. In Korea, the combination therapy of the metformin and dipeptidyl peptidase 4 (DPP4) inhibitors is preferred to the sodium-glucose cotransporter 2 (SGLT2) inhibitors. The American Diabetes Association (ADA) has stated that the SGLT2 inhibitors can be used in combination with the metformin in parallel with the DPP4 inhibitors. But, there is a lack of direct comparative studies of the SGLT2 inhibitors and the DPP4 inhibitors in Korea. The purpose of this study was to compare the efficacy of the SGLT2 and the DPP4 inhibitors add-on to metformin therapy. Methods : This was a retrospective study conducted June 2018-May 2019. This study investigated the medical records of patients administered with metformin and SGLT2 or DPP4 inhibitors. Results : Of the total of 155 patients, 46 were administered with the metformin and the SGLT2 inhibitors (SGLT2-I group) and the remaining patients were administered with the DPP4 inhibitors (DPP4-I group). There was no significant difference in the average change in HbA1c and fasting blood sugar (FBS) in both groups (p=0.102, p=0.512). However, the average change in body weight decreased by 8.7±17.7 kg in the SGLT2-I group and increased by 0.3±3.9 kg in the DPP4-I group (P<0.001). The average change in the mean arterial pressure (MAP) decreased by 6.6±8.0 mmHg in the SGLT2-I group and 0.2±13.3 mmHg in the DPP4-I group (p=0.001). The average creatinine clearance (CrCl) change increased by 5.5±24.3 mL/min in the SGLT2-I group and 0.4±10.3 mL/min in the DPP4-I group (P=0.001). There was no significant difference in the incidence of hypoglycemia and urinary tract infections between the two groups (p=0.507, p=0.079, respectively). Conclusion : In summary, the SGLT2-I group was more effective in reducing body weight and the MAP and improving the CrCl than the DPP4-I group. So, we suggest that the SGLT2 inhibitors may be considered as the first choice in combination with the metformin in patients with a high risk of diabetic complications.
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