ADA: Thiazolidinediones, sulfonylureas best DPP-4s for metformin-based dual GLT

BOSTON – Adding a dipeptidyl peptidase-4 (DPP-4) inhibitor to metformin in patients with type 2 diabetes was associated with an increased, earlier need for treatment intensification, compared with adding a sulfonylurea in a large, retrospective, population-based study in the United Kingdom.

Conversely, adding a thiazolidinedione as a second-line glucose-lowering agent resulted in the most durable glycemic response, Jil Mamza reported at the annual scientific sessions of the American Diabetes Association.

Unadjusted survival analysis showed that 23% of 3,080 patients treated with second-line DDP-4 agents experienced treatment failure at 1 year, compared with 15% of 15,508 on a sulfonylurea, and 8% of 1,582 on a thiazolidinedione. The corresponding failure rates at 2 years were 38%, 26% and 12%, said Mr. Mamza, a clinical researcher and doctoral student at the University of Nottingham, Derby, England.

After multivariate adjustment, adding a DPP-4 inhibitor was associated with an increased hazard of intensification of therapy (adjusted hazard ratio, 1.58), while adding a thiazolidinedione was associated with a reduced hazard (adjusted HR, 0.45).

Several baseline factors were also shown to be associated an increased hazard of intensification, including hemoglobin A_1c level, diabetes duration, gender, smoking status, and the use of lipid-lowering medications, he said.

Patients included in this study were adults with a mean age of 60 years and a mean disease duration of 3 years from the The Health Initiative Network (THIN) database of United Kingdom general practice patients. All those included had added a second oral glucose lowering therapy (GLT) to metformin between 2007 and 2014.

Time to dual therapy failure was defined as time to treatment substitution or intensification with a third agent at an HbA_1c level greater than 58 mmol/mol.

The durability of glycemic response for different second-line treatments was previously unclear. These findings suggest that DPP-4 agents provide the least durable response, compared with sulfonylureas and thiazolidinediones as second-line GLTs, Dr. Mamza said.

Mr. Mamza reported having no disclosures.

[email protected]

BOSTON – Adding a dipeptidyl peptidase-4 (DPP-4) inhibitor to metformin in patients with type 2 diabetes was associated with an increased, earlier need for treatment intensification, compared with adding a sulfonylurea in a large, retrospective, population-based study in the United Kingdom.

Conversely, adding a thiazolidinedione as a second-line glucose-lowering agent resulted in the most durable glycemic response, Jil Mamza reported at the annual scientific sessions of the American Diabetes Association.

Unadjusted survival analysis showed that 23% of 3,080 patients treated with second-line DDP-4 agents experienced treatment failure at 1 year, compared with 15% of 15,508 on a sulfonylurea, and 8% of 1,582 on a thiazolidinedione. The corresponding failure rates at 2 years were 38%, 26% and 12%, said Mr. Mamza, a clinical researcher and doctoral student at the University of Nottingham, Derby, England.

After multivariate adjustment, adding a DPP-4 inhibitor was associated with an increased hazard of intensification of therapy (adjusted hazard ratio, 1.58), while adding a thiazolidinedione was associated with a reduced hazard (adjusted HR, 0.45).

Several baseline factors were also shown to be associated an increased hazard of intensification, including hemoglobin A_1c level, diabetes duration, gender, smoking status, and the use of lipid-lowering medications, he said.

Patients included in this study were adults with a mean age of 60 years and a mean disease duration of 3 years from the The Health Initiative Network (THIN) database of United Kingdom general practice patients. All those included had added a second oral glucose lowering therapy (GLT) to metformin between 2007 and 2014.

Time to dual therapy failure was defined as time to treatment substitution or intensification with a third agent at an HbA_1c level greater than 58 mmol/mol.

The durability of glycemic response for different second-line treatments was previously unclear. These findings suggest that DPP-4 agents provide the least durable response, compared with sulfonylureas and thiazolidinediones as second-line GLTs, Dr. Mamza said.

Mr. Mamza reported having no disclosures.

[email protected]

BOSTON – Adding a dipeptidyl peptidase-4 (DPP-4) inhibitor to metformin in patients with type 2 diabetes was associated with an increased, earlier need for treatment intensification, compared with adding a sulfonylurea in a large, retrospective, population-based study in the United Kingdom.

Conversely, adding a thiazolidinedione as a second-line glucose-lowering agent resulted in the most durable glycemic response, Jil Mamza reported at the annual scientific sessions of the American Diabetes Association.

Unadjusted survival analysis showed that 23% of 3,080 patients treated with second-line DDP-4 agents experienced treatment failure at 1 year, compared with 15% of 15,508 on a sulfonylurea, and 8% of 1,582 on a thiazolidinedione. The corresponding failure rates at 2 years were 38%, 26% and 12%, said Mr. Mamza, a clinical researcher and doctoral student at the University of Nottingham, Derby, England.

After multivariate adjustment, adding a DPP-4 inhibitor was associated with an increased hazard of intensification of therapy (adjusted hazard ratio, 1.58), while adding a thiazolidinedione was associated with a reduced hazard (adjusted HR, 0.45).

Several baseline factors were also shown to be associated an increased hazard of intensification, including hemoglobin A_1c level, diabetes duration, gender, smoking status, and the use of lipid-lowering medications, he said.

Patients included in this study were adults with a mean age of 60 years and a mean disease duration of 3 years from the The Health Initiative Network (THIN) database of United Kingdom general practice patients. All those included had added a second oral glucose lowering therapy (GLT) to metformin between 2007 and 2014.

Time to dual therapy failure was defined as time to treatment substitution or intensification with a third agent at an HbA_1c level greater than 58 mmol/mol.

The durability of glycemic response for different second-line treatments was previously unclear. These findings suggest that DPP-4 agents provide the least durable response, compared with sulfonylureas and thiazolidinediones as second-line GLTs, Dr. Mamza said.

Mr. Mamza reported having no disclosures.

[email protected]