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Is Concurrent Insulin, DPP-4 Therapy Safe for Type 2 Diabetes Patients?

July 02, 2018

Despite dipeptidyl peptidase-4 (DPP-4) therapy often being discontinued at the start of insulin therapy, new research has shown that continuation of treatment with the DPP-4 inhibitor sitagliptin upon initiation of insulin therapy is associated with improved glycemic outcomes.

These findings emerged from a study of 746 patients with type 2 diabetes (mean hemoglobin A1c[HbA1c] 8.8%) that was inadequately controlled with metformin in dual or triple combination therapy with a DPP-4 inhibitor and/or sulfonylurea.

Patients who were on once-daily 100 mg metformin plus sitagliptin immediately entered the trial, and all other patients were switched to metformin plus sitagliptin therapy and were stabilized during a run-in period.

Subsequently, participants were randomly assigned to either continue sitagliptin or switch to matching placebo. All participants initiated insulin, which was titrated based on fasting glucose.

Results indicated that continuing sitagliptin was superior to discontinuing sitagliptin after 30 weeks in reducing HbA1c.

In addition, event rates of documented symptomatic low blood sugar—defined as a blood glucose of 70 mg/dL or less—were found to be lower in patients who received sitagliptin along with a daily dose of insulin compared with those who discontinued sitagliptin.

Adverse events and changes in body weight were similar between groups.

“In summary, with the initiation of insulin therapy, continuation of [sitagliptin] resulted in superior glycemic efficacy” and fewer documented instances of low blood sugar, the researchers concluded.

These new findings were presented at the American Diabetes Association’s 78th Scientific Sessions.

—Christina Vogt

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