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Combination sitagliptin/metformin improves glycemic control
In Korean adults with type 2 diabetes, combination sitagliptin and metformin as first-line therapy showed a greater improvement in glycemic control and fasting plasma glucose at 30 weeks vs. glimepiride monotherapy, according to findings from a randomized controlled trial.
“Per current practices, glimepiride is the first-line therapy for [type 2 diabetes] in Korea,” Sang Soo Kim, MD, PhD, of the Biomedical Research Institute at Pusan National University Hospital in Busan, South Korea, and colleagues wrote. “The results of the present study suggest that [sitagliptin/metformin fixed-dose combination] is probably a good candidate for initial therapy in patients with [type 2 diabetes] compared with glimepiride monotherapy. Given the current recommendations on the use of combination therapy for early initial treatment if target HbA1c levels are not achieved, these findings have important clinical implications in diabetes management in Korea.”
In a double blind, multicenter study, Kim and colleagues analyzed data from 292 adults with type 2 diabetes randomly assigned to combination sitagliptin/metformin therapy 50/1,000 mg twice daily (Janumet; Merck; n = 147) or glimepiride 6 mg daily (n = 145) for 30 weeks (mean age, 54 years; 165 men; mean BMI, 25.1 kg/m²; mean HbA1c, 8%; mean diabetes duration, 4.2 years). Primary endpoint was change in HbA1c; secondary endpoints included the proportion of patients reaching an HbA1c of 7% or less and change from baseline in fasting plasma glucose.
At 30 weeks, participants assigned sitagliptin plus metformin saw a greater reduction in HbA1c vs. those assigned glimepiride therapy (–1.49% vs. –0.71%; between-group difference, –0.78; 95% CI, –0.96 to –0.59). In addition, more patients in the combination group reached the target HbA1c of 7% or less vs. the glimepiride group (81.2% vs. 40.1%; P < .001) and saw a greater reduction in FPG (least-squares mean difference, –23.5mg/dL; P < .001).
Drug-related adverse event rates were similar in both groups (25.3% for combination group and 27.1% for glimepiride group); there were no serious adverse events or deaths.
Participants in the sitagliptin/metformin group experienced fewer hypoglycemia events (5.5% vs. 20.1%) and less weight gain (–0.83 kg vs. 90 kg) vs. those assigned glimepiride (P < .001 for both). – by Regina Schaffer
Disclosure: One researcher reports being an employee of MSD Korea Ltd.