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Comparison of treatment with sitagliptin or sulfonylurea in patients with type 2 diabetes mellitus and mild renal impairment: a post hoc analysis of clinical trials.

Ommen ES, Xu L, O'Neill EA, Goldstein BJ, Kaufman KD, Engel SS - Diabetes Ther (2015)

Bottom Line: HbA1c and FPG decreased similarly with sitagliptin or sulfonylurea.Body weight decreased with sitagliptin but increased with sulfonylurea.A greater percentage of subjects treated with sitagliptin (41.1%) than treated with sulfonylurea (16.9%) achieved the composite endpoint of >0.5% HbA1c reduction with no symptomatic hypoglycemia or body weight gain.

View Article: PubMed Central - PubMed

Affiliation: Merck & Co., Inc., Whitehouse Station, NJ, USA, elizabeth.ommen@merck.com.

ABSTRACT

Introduction: Impaired renal function is a major complication of type 2 diabetes mellitus (T2DM). Mild renal impairment is present in 38% of patients with T2DM and may impact choice of antihyperglycemic agent. Sulfonylureas and dipeptidyl peptidase-4 (DPP-4) inhibitors are commonly used to treat hyperglycemia in patients with T2DM and renal impairment. Although in general sulfonylurea use is associated with an increased risk of hypoglycemia and weight gain, while DPP-4 inhibitor use is associated with a low risk of hypoglycemia, and is weight neutral, the relative efficacy and tolerability of these agents in patients with mild renal impairment has not been evaluated.

Methods: In a post hoc analysis, data from 1,211 subjects with T2DM and mild renal impairment (estimated glomerular filtration rates of 60 to <90 mL/min/1.73 m(2)), who completed 25 or 30 weeks of one of three double-blind clinical trials comparing the DPP-4 inhibitor sitagliptin 100 mg/day with sulfonylureas in titrated doses, were pooled. The analysis compared change from baseline in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), body weight, incidence of symptomatic hypoglycemia and the percentages of subjects meeting a composite endpoint of HbA1c decrease >0.5% without symptomatic hypoglycemia or body weight gain between sitagliptin and sulfonylurea treatment groups.

Results: HbA1c and FPG decreased similarly with sitagliptin or sulfonylurea. A lower incidence of hypoglycemia was observed with sitagliptin. Body weight decreased with sitagliptin but increased with sulfonylurea. A greater percentage of subjects treated with sitagliptin (41.1%) than treated with sulfonylurea (16.9%) achieved the composite endpoint of >0.5% HbA1c reduction with no symptomatic hypoglycemia or body weight gain.

Conclusion: In this analysis of subjects with T2DM and mild renal impairment, treatment with sitagliptin provided glycemic efficacy similar to sulfonylurea, with less hypoglycemia and with body weight loss compared to body weight gain seen with sulfonylurea.

Trial registrations: ClinicalTrials.gov #NCT00482079, #NCT00094770, #NCT00701090.

No MeSH data available.


Related in: MedlinePlus

Glycated hemoglobin (HbA1c) change from baseline after 25–30 weeks of treatment with sitagliptin or a sulfonylurea. CI confidence interval, LS least squares
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Fig1: Glycated hemoglobin (HbA1c) change from baseline after 25–30 weeks of treatment with sitagliptin or a sulfonylurea. CI confidence interval, LS least squares

Mentions: Changes from baseline in HbA1c were similar between the sitagliptin- and the sulfonylurea-treated groups (sitagliptin = −0.62%, sulfonylurea = −0.68%; sitagliptin difference from sulfonylurea group 0.06%, P = 0.104; Fig. 1). The percentages of subjects with HbA1c < 7.0% or with >0.5% reduction in HbA1c were also similar between the two groups (differences from sulfonylurea group −4.7%, P = 0.092, Fig. 2 and 0.2%, P = 0.956, Fig. 3, respectively). The FPG changes from baseline observed with sitagliptin treatment and with sulfonylurea treatment at Weeks 25 or 30 (Fig. 4) were similar (difference from sulfonylurea group 1.6 mg/dL, P = 0.298).Fig. 1


Comparison of treatment with sitagliptin or sulfonylurea in patients with type 2 diabetes mellitus and mild renal impairment: a post hoc analysis of clinical trials.

Ommen ES, Xu L, O'Neill EA, Goldstein BJ, Kaufman KD, Engel SS - Diabetes Ther (2015)

Glycated hemoglobin (HbA1c) change from baseline after 25–30 weeks of treatment with sitagliptin or a sulfonylurea. CI confidence interval, LS least squares
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4374078&req=5

Fig1: Glycated hemoglobin (HbA1c) change from baseline after 25–30 weeks of treatment with sitagliptin or a sulfonylurea. CI confidence interval, LS least squares
Mentions: Changes from baseline in HbA1c were similar between the sitagliptin- and the sulfonylurea-treated groups (sitagliptin = −0.62%, sulfonylurea = −0.68%; sitagliptin difference from sulfonylurea group 0.06%, P = 0.104; Fig. 1). The percentages of subjects with HbA1c < 7.0% or with >0.5% reduction in HbA1c were also similar between the two groups (differences from sulfonylurea group −4.7%, P = 0.092, Fig. 2 and 0.2%, P = 0.956, Fig. 3, respectively). The FPG changes from baseline observed with sitagliptin treatment and with sulfonylurea treatment at Weeks 25 or 30 (Fig. 4) were similar (difference from sulfonylurea group 1.6 mg/dL, P = 0.298).Fig. 1

Bottom Line: HbA1c and FPG decreased similarly with sitagliptin or sulfonylurea.Body weight decreased with sitagliptin but increased with sulfonylurea.A greater percentage of subjects treated with sitagliptin (41.1%) than treated with sulfonylurea (16.9%) achieved the composite endpoint of >0.5% HbA1c reduction with no symptomatic hypoglycemia or body weight gain.

View Article: PubMed Central - PubMed

Affiliation: Merck & Co., Inc., Whitehouse Station, NJ, USA, elizabeth.ommen@merck.com.

ABSTRACT

Introduction: Impaired renal function is a major complication of type 2 diabetes mellitus (T2DM). Mild renal impairment is present in 38% of patients with T2DM and may impact choice of antihyperglycemic agent. Sulfonylureas and dipeptidyl peptidase-4 (DPP-4) inhibitors are commonly used to treat hyperglycemia in patients with T2DM and renal impairment. Although in general sulfonylurea use is associated with an increased risk of hypoglycemia and weight gain, while DPP-4 inhibitor use is associated with a low risk of hypoglycemia, and is weight neutral, the relative efficacy and tolerability of these agents in patients with mild renal impairment has not been evaluated.

Methods: In a post hoc analysis, data from 1,211 subjects with T2DM and mild renal impairment (estimated glomerular filtration rates of 60 to <90 mL/min/1.73 m(2)), who completed 25 or 30 weeks of one of three double-blind clinical trials comparing the DPP-4 inhibitor sitagliptin 100 mg/day with sulfonylureas in titrated doses, were pooled. The analysis compared change from baseline in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), body weight, incidence of symptomatic hypoglycemia and the percentages of subjects meeting a composite endpoint of HbA1c decrease >0.5% without symptomatic hypoglycemia or body weight gain between sitagliptin and sulfonylurea treatment groups.

Results: HbA1c and FPG decreased similarly with sitagliptin or sulfonylurea. A lower incidence of hypoglycemia was observed with sitagliptin. Body weight decreased with sitagliptin but increased with sulfonylurea. A greater percentage of subjects treated with sitagliptin (41.1%) than treated with sulfonylurea (16.9%) achieved the composite endpoint of >0.5% HbA1c reduction with no symptomatic hypoglycemia or body weight gain.

Conclusion: In this analysis of subjects with T2DM and mild renal impairment, treatment with sitagliptin provided glycemic efficacy similar to sulfonylurea, with less hypoglycemia and with body weight loss compared to body weight gain seen with sulfonylurea.

Trial registrations: ClinicalTrials.gov #NCT00482079, #NCT00094770, #NCT00701090.

No MeSH data available.


Related in: MedlinePlus