M D Garcia de Lucas1, L M Pérez Belmonte2, M Suárez Tembra3, J Olalla Sierra4, R Gómez Huelgas2. 1. Internal medicine, Hospital Costa del Sol, autovia A7, Málaga, E-29030 Marbella, Spain. Electronic address: gdelucaslola@gmail.com. 2. Hospital Regional Universitario (IBIMA), Málaga and CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Malaga, Spain. 3. Hospital San Rafael, Coruña, Spain. 4. Internal medicine, Hospital Costa del Sol, autovia A7, Málaga, E-29030 Marbella, Spain.
Abstract
AIM: To analyze the efficacy and safety of replacing sitagliptin with canagliflozin in patients with type 2 diabetes (T2D) and poor metabolic control despite treatment with sitagliptin in combination with metformin and/or gliclazide. MATERIALS AND METHODS: In this multicentre observational, retrospective, 26-week clinical study of patients with T2D and poor glycaemic control (HbA1c: 7.5-9.5%) treated with sitagliptin in combination with metformin and/or gliclazide, sitagliptin (and gliclazide if appropriate) were replaced by canagliflozin. The main outcome of the study was the proportion of patients who achieved good glycaemic control (HbA1c<7%) by the end of the study. RESULTS: The study sample comprised 50 patients (baseline HbA1c 8.0±0.6%) treated with sitagliptin 100mg/day, 14 of whom were also taking gliclazide 60mg/day while 38 were taking metformin 1700mg/day. Sitagliptin treatment was replaced by either canagliflozin 100mg (n=17) or 300mg (n=33). After 26 weeks of follow-up, these patients presented with significant decreases in HbA1c (-1.1%; P<0.000), weight (-3.89kg; P<0.000), BMI (-1.37kg/m2; P<0.022), abdominal circumference (-5.42cm; P<0.004), systolic and diastolic blood pressure (-5.3mmHg and -4.4mmHg, respectively; P=0.005), triglycerides (-42mg/dL; P=0.005) and LDL/HDL cholesterol ratio (-0.34; P=0.005). By the end of the study, 42% of patients had achieved HbA1c levels<7%. CONCLUSION: In patients with T2D poorly controlled with sitagliptin, whether alone or in combination with metformin and/or gliclazide, replacing it with canagliflozin may be a simple yet effective intensification strategy. Our results, which may have important implications for clinical practice, now need to be confirmed in larger observational studies.
AIM: To analyze the efficacy and safety of replacing sitagliptin with canagliflozin in patients with type 2 diabetes (T2D) and poor metabolic control despite treatment with sitagliptin in combination with metformin and/or gliclazide. MATERIALS AND METHODS: In this multicentre observational, retrospective, 26-week clinical study of patients with T2D and poor glycaemic control (HbA1c: 7.5-9.5%) treated with sitagliptin in combination with metformin and/or gliclazide, sitagliptin (and gliclazide if appropriate) were replaced by canagliflozin. The main outcome of the study was the proportion of patients who achieved good glycaemic control (HbA1c<7%) by the end of the study. RESULTS: The study sample comprised 50 patients (baseline HbA1c 8.0±0.6%) treated with sitagliptin 100mg/day, 14 of whom were also taking gliclazide 60mg/day while 38 were taking metformin 1700mg/day. Sitagliptin treatment was replaced by either canagliflozin 100mg (n=17) or 300mg (n=33). After 26 weeks of follow-up, these patients presented with significant decreases in HbA1c (-1.1%; P<0.000), weight (-3.89kg; P<0.000), BMI (-1.37kg/m2; P<0.022), abdominal circumference (-5.42cm; P<0.004), systolic and diastolic blood pressure (-5.3mmHg and -4.4mmHg, respectively; P=0.005), triglycerides (-42mg/dL; P=0.005) and LDL/HDL cholesterol ratio (-0.34; P=0.005). By the end of the study, 42% of patients had achieved HbA1c levels<7%. CONCLUSION: In patients with T2D poorly controlled with sitagliptin, whether alone or in combination with metformin and/or gliclazide, replacing it with canagliflozin may be a simple yet effective intensification strategy. Our results, which may have important implications for clinical practice, now need to be confirmed in larger observational studies.
Authors: Luis M Pérez-Belmonte; Michele Ricci; Jaime Sanz-Cánovas; Lidia Cobos-Palacios; María D López-Carmona; M Isabel Ruiz-Moreno; Mercedes Millán-Gómez; M Rosa Bernal-López; Sergio Jansen-Chaparro; Ricardo Gómez-Huelgas Journal: J Clin Med Date: 2021-05-08 Impact factor: 4.241