Effects on Metabolic Parameters of Addition of SGLT‐2 Inhibitors on Patients with Type2 Diabetes Inadequately Controlled with DPP‐IV Inhibitors and Metformin

Diabetes and Obesity International Journal

Diabetes Obes Int J 2019, 4(2): 000201


Background: Practice guidelines are open regarding choice of therapy after metformin. The second line agent’s insulin

(INS), sulphonylureas (SU) and thiazolidinediones (TZD) may cause either hypoglycaemia or weight gain. Dipeptidyl

peptidase‐IV (DPP-4) inhibitors are unlikely to produce that. Sodium‐glucose transporter‐2 (SGLT -2) inhibitors are

newer agents with the advantage of weight loss. Indian data regarding combination therapy with Metformin withDPP-4

inhibitors plus SGLT-2 inhibitors arescanty; hence this study is relevant .Moreover the number of patients studied,

duration of study, study variables and effects of three SGLT-2inhibitors were analyzed separately.

Objectives: To study the glycaemic and other metabolic parameters after treatment with SGLT‐2 inhibitors-canagliflozin

or, dapagliflozin, or, empagliflozin in type 2 Diabetes (T2DM) patient inadequately controlled (HbA1c >7.5%) with DPP-4

inhibitors plus metformin.

Methodology: Data of 101 T2DM patients inadequately controlled (HbA1c> 7.5%) with DPP-4 inhibitors plus metformin

who were prescribed canagliflozin 100 mg or, dapagliflozin 5 or 10 mg, or empagliflozin 10 mg or 25 mg once daily with

mean follow‐up duration of 23 weeks were analyzed. Subjects receiving INS, SU and TZD were excluded from analysis.

Changes in weight, blood pressure, glycaemia, lipids, renal and hepatic parameters were studied. Subgroup analyses were

done to see effects of three SGLT‐2 inhibitors.

Results: Results showed that addition of SGLT-2 inhibitors produced favourable effects on all metabolic parameters


Conclusion: Our study shows that addition of SGLT2 inhibitors on existing therapy with DPP-4 inhibitors and metformin

produces favourable effects on metabolic parameters with the advantage of weight loss and without producing major

hypoglycaemic events.

Keywords: SGLT-2 inhibitors; DPP-4 inhibitors; Metformin; T2D

May 2019
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