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