Sitagliptin Add-On Improves Glycemic Measures After Metformin Dosage Increase in Type 2 Diabetes

The addition of sitagliptin to metformin therapy may be a useful strategy to avoid hyperglycemia during the process of metformin up-titration.

SAN FRANCISCO — Addition of sitagliptin to metformin may be a more effective strategy to improve glycemic control in patients with type 2 diabetes (T2D) compared with an increase in metformin dosage alone, according to study results presented at the American Diabetes Association 79th Scientific Sessions, held June 7 to 11, 2019.

In patients who require up-titration of metformin, addition of an antihyperglycemic agent earlier in the process of increasing dosage may reduce exposure to hyperglycemia. Researchers compared the addition of dipeptidyl peptidase-4 inhibitor sitagliptin (n = 223) vs placebo (n = 210) in patients with uncontrolled T2D whose metformin dose was being increased from 1000 mg/d to 2000 mg/d.

At baseline, participants had an average hemoglobin A1c (HbA1c) of 8.6%. Patients receiving metformin plus sitagliptin were more likely to achieve HbA1c treatment goals compared with patients receiving metformin plus placebo.

In a post hoc analysis, the researchers analyzed the influence of baseline HbA1c on likelihood of achieving post-treatment HbA1c goal. They found that as overall difference in baseline HbA1c to goal HbA1c increased, the likelihood of achieving the goal decreased. Patients receiving sitagliptin were generally more likely to achieve goal HbA1c compared with those receiving placebo.

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“Clinical inertia remains a significant obstacle in real-world practice, as the failure to implement stepwise addition of antihyperglycemic agents in a timely way results in prolonged exposure to hyperglycemia in many patients,” said Sam Engel, MD, Associate Vice President, diabetes, endocrinology, and women’s health at Merck Research Laboratories, and coauthor of the study.

“Future research that further characterizes the role of initial combination therapy, or early introduction of a second antihyperglycemic agent, will provide data that can help providers make evidence-based decisions, especially in the context of patient-specific glycemic goals.”

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Crutchlow M, Lin J, Lam RL, O’Neill EA, Kaufman KD, Engel SS. A1c goal attainment after metformin (MET) up-titration with and without sitagliptin (SITA): impact of baseline and target A1c. Presented at: American Diabetes Association 79th Scientific Sessions; June 7-11, 2019; San Francisco, CA. Poster 1149-P.