Comparative efficacy and safety of DPP-4 inhibitors and α-glucosidase inhibitors as add on therapy in type 2 diabetes

Authors

  • Rajit Sahai Department of Pharmacology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
  • Taruna Sharma Department of Pharmacology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
  • Dilip C. Dhasmana Department of Pharmacology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
  • Nidhi Kaeley Department of General Medicine, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20181173

Keywords:

Type 2 diabetes, Sitagliptin, Voglibose

Abstract

Background: Diabetes mellitus (DM) is a spectrum of metabolic disorders as a consequence of different pathogenic mechanisms resulting in hyperglycemia. A genetic predisposition to develop β-cell dysfunction synergizes with insulin resistance to lead to type 2 DM. Adequate management of type 2 DM requires institution of non pharmacological treatment followed by pharmacological treatment. Monotherapy is started initially followed by combination therapy (dual/triple). Sitagliptin, a DPP-4 inhibitor and voglibose, an α-glucosidase inhibitor has been implicated as an add on therapy to metformin and glimepiride. So, we aimed to assess the efficacy and safety of the sitagliptin and voglibose as add on therapy to metformin and glimepitide in type 2 DM.

Methods: This open label randomized control trial was conducted in the department of Pharmacology among patients attending medicine OPD of a tertiary care hospital. 80 patients were randomly divided into two groups of 40 patients each. group A:sitagliptin + metformin + glimepiride and group B:voglibose + metformin + glimepiride. Patients were followed every week for a period of 12 weeks. Data was analysed using paired t test, unpaired t test and chi square test.

Results: There was a significant decrease in HbA1c, FPG and PPG in both the groups. Intergroup comparison at 4, 8 and 12 weeks showed a better improvement in glycemic control in group A as compared to group B.

Conclusions: Sitagliptin showed a better glycemic control than that with voglibose in patients with uncontrolled type 2 DM on metformin and glimepiride.

References

Powers CA. Diabetes Mellitus. In: Kasper LD, Fauci SA, Hauser LS, Longo LD, Jameson LJ, Loscalzo J. Harrison’s principles of internal medicine: 19th ed. United States of America: Mc Graw Hill Education; 2015:2399.

Ahirwar D, Tandia K, Agarawal S. Study of prevalence of diabetes mellitus in tertiary centre of Sagar. IOSR Journal of Dental and Medical Sciences. 2017;16:99-102.

Fonseca V. Clinical significance of targeting postprandial and fasting hyperglycemia in managing type 2 diabetes mellitus. Curr Med Res Opin. 2003;19:635-41.

Ceriello A. The glucose triad and its role in comprehensive glycaemic control: current status, future management. Int J Clin Pract. 2010;64(12):1705-11.

Setter SM, Iltz JL, Thams J, Campbell RK. Metformin hydrochloride in the treatment of type 2 diabetes mellitus: a clinical review with a focus on dual therapy. Clin Ther. 2003;25:2991-3026.

Cook MN, Girman CJ, Stein PP, Alexander CM, Holman RR. Glycemic control continues to deteriorate after sulfonylureas are added to metformin among patients with type 2 diabetes. Diabetes Care. 2005;28:995-1000.

Inzucchi SE. Oral antihyperglycemic therapy for type 2 diabetes: scientific review. JAMA. 2002;287:360-72.

Kalra S, Aamir AH, Raza A, Das AK, Khan AA, Shreshtha D, et al. Place of sulfonylureas in the management of type 2 diabetes mellitus in South Asia: A consensus statement. Ind J Endocrinol Meta. 2015;19(5):577-96.

Rodbard H, Jellinger P, Davidson J, Einhorn D, Garber A, Grunberger G, et al. Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: an algorithm for glycemic control. Endocrine practice. 2009;15(6):540-59.

Karasik A, Aschner P, Katzeff H, Davies MJ, Stein PP. Sitagliptin, a DPP-4 inhibitor for the treatment of patients with type 2 diabetes: a review of recent clinical trials. Curr Med Res Opin. 2008;24:489-96.

Mohan V, Yang W, Son HY, Xu L, Noble L, Langdon RB, et al. Efficacy and safety of sitagliptin in the treatment of patients with type 2 diabetes in China, India and Korea. Diab Res Clin Pract. 2009;83:106-116.

Yang W, Lin L, Qi J. The preventive effect of acarbose and metformin on the IGT population from becoming diabetes mellitus: a 3-year multicentral prospective study. Chin J Endocrinol Metab. 2001;17:131-4.

Phung OJ, Sobieraj DM, Engel SS, Rajpathak SN. Early combination therapy for the treatment of type 2 diabetes mellitus: systematic review and meta-analysis. Diabetes Obes Metab. 2014;16:410-7.

Matsushima Y, Takeshita Y, Kita Y, Otoda T, Kato KI,Wakkuri HT, et al. Pleiotropic effects of sitagliptin versus voglibose in patients with type 2 diabetes inadequately controlled via diet and/or a single oral antihyperglycemic agent: a multicenter randomized trial. BMJ Open Diabetes Res Care. 2016;4:e000190.

Gupta R, Rehan H, Rohatgi A, Bhatacharjee J, Chopra D. The effect of glipizide, metformin and rosiglitazone on non traditional cardiovascular risk factors in newly diagnosed patients with type 2 diabetes mellitus. Inter J Diabetes developing countries. 2010;30(3):123-8.

Hermansen K, Kipnes M, Luo E, Fanurik D, Khatami H, Stein P. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor, sitagliptin, in patients with type 2 diabetes mellitus inadequately controlled on glimepiride alone or on glimepiride and metformin. Diabetes, Obesity Metabolism. 2007;9:733-45.

Rao C, Faruqui. Efficacy and safety of oral triple drug combination (voglibose, glimepiride and metformin) in the management of type 2 diabetes mellitus. Int J Cur Res Rev. 2013;5(16):20-6.

Yokoh H, Kobayashi K, Sato Y, Takemoto M, Uchida D, Kanatsuka A, et al. Efficacy and safety of dipeptidyl peptidase-4 inhibitor sitagliptin compared with alpha-glucosidase inhibitor in Japanese patients with type 2 diabetes inadequately controlled on metformin or pioglitazone alone (Study for and ultimate combination theapy to control diabetes with sitagliptin-1): A multicenter, randomized, open label, non-inferiority trial. J Diabetes Invest. 2015;6(2):182-91.

Schernthaner G, Gross JL, Rosenstock J, Guarisco M, Fu M, Yee J, et al. Canagliflozin compared with Sitagliptin for Patients with Type 2 Diabetes who do not have adequate glycemic control with Metformin plus Sulfonylurea: A 52-week randomized trial. Diabetes Care. 2013;36(9):2508-15.

Jha VK, Faruqui AA. Evaluation of safety and efficacy of triple drug fixed dose combination of voglibose, glimepiride and metformin in type 2 diabetes mellitus. Int J Clin Surg adv. 2014;2(4):26-33.

Liu SC, Chien KL, Wang CH, Chen WC, Leung CH. Efficacy and safety of adding pioglitazone or sitagliptin to patients with type 2 diabetes insufficiently controlled with metformin and sulfonylurea. Endocrine practice. 2013;19(6):980-8.

Nauck MA, Meininger G, Sheng D, Terranella L, Stein PP. Efficacy and safety of dipeptidyl peptidase-4 inhibitor, stagliptin compared with sulfonylurea, glipizide in patients with type 2 diabetes inadequately controlled on metformin alone: a randomized, double-blind, non inferiority trial. Diabetes, Obesity Metabolism. 2007;(9):194-205.

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Published

2018-03-23

How to Cite

Sahai, R., Sharma, T., Dhasmana, D. C., & Kaeley, N. (2018). Comparative efficacy and safety of DPP-4 inhibitors and α-glucosidase inhibitors as add on therapy in type 2 diabetes. International Journal of Basic & Clinical Pharmacology, 7(4), 707–713. https://doi.org/10.18203/2319-2003.ijbcp20181173

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Original Research Articles