Should you: Stop a DPP-4i when you start insulin? Prescribe initial triple combination Rx? What about SGLT2i + DPP-4i + MET vs insulin + MET? Find out.
Studies at the ADA 78th Scientific Sessions included these 3 on oral antidiabetic agents and insulin that examine:
Efficacy and safety of continuing sitagliptin when initiating insulin therapy in subjects with type 2 diabetes
Is it Safe to Continue SITA when it’s Time to Initiate INS? Double-blind RCT in 764 subjects with T2DM uncontrolled by metformin (MET) in a dual or triple combination with DPP-4i and/or sulfonylurea.
Post-Prandial Control + Reduced Insulin Dose + Glucose-dependent MOA. Study authors suggest that continuing a DPP-4i when initating insulin improves glycemic control via better control of PPG and reduces risk of hypoglycemia via lowered insulin dose and glucagonotropic effects of glucose-dependent insulinotropic ploypeptide during hypoglycemia. Link to ADA Abstract.
Dapagliflozin plus saxagliptin shows noninferior A1c reduction vs insulin glargine in patients with type 2 diabetes inadequately controlled by metformin with or without sulfonylurea
SGLT2i + DPP-4i + MET vs Insulin + MET. A combination of dapagliflozin (DAPA), saxagliptin (SAXA) and metformin (MET) produced reduction in A1c comparable to insulin glargine (INS) + MET in patients with T2DM poorly controlled by MET with or without sulfonylurea (SU).
DAPA + SAXA + MET Noninferior to INS + MET. Conclusion: DAPA + SAXA therapy resulted in similar glycemic control, prevented weight gain, and reduced risk of hypoglycemia compared with titrated INS in patients with T2DM poorly controlled by MET ± SU. Link to ADA Abstract.
Durable HbA1c reduction with initial combination therapy with metformin/pioglitazone/exenatide in subjects with new-onset diabetes: Six-year follow-up of the EDICT Study (Efficacy and durability of initial combination therapy for type 2 diabetes)
EDICT 6-year Follow-up. Newly diagnosed, drug-naÑve patients with new-onset T2DM treated with triple therapy (metformin/pioglitazone/exenatide) achieved better results than those initially treated with an escalating dose of metformin (MET) followed by sequential addition of glipizide (GLIP) and glargine insulin (INS).
Triple Combo Rx of Oral/Injectable Superior to Conventional Step Therapy. The results demonstrate that combination therapy with metformin/pioglitazone/exenatide in newly diagnosed T2DM patients produces greater and more reduction in A1c than conventional sequential add-on therapy with metformin, sulfonylurea, and basal insulin. Link to ADA Abstract.