Efficacy of Concomitant DPP-4 Inhibitor With Insulin Glargine in T2D

Individuals with uncontrolled type 2 diabetes who are taking concomitant dipeptidyl peptidase-4 (DPP-4) inhibitor with basal insulin may benefit from therapy with insulin glargine 300 U/mL (Gla-300), according to a study published in PLoS One.¹

As type 2 diabetes progresses, patients often require combination therapy with one or more oral antihyperglycemic drugs and/or non-insulin injectable antihyperglycemic drugs, as well as basal insulin or more complex insulin regimens.²

DPP-4 inhibitor therapy is becoming an increasingly popular class of oral antihyperglycemic drugs because they are associated with a lower risk for hypoglycemia compared with sulfonylureas or glinides.³

Two previous multicenter, randomized, open-label, parallel-group, phase 3a studies (ClinicalTrials.gov identifier: NCT01499095; NCT01676220) demonstrated that Gla-300 provides comparable glycemic control to insulin glargine 100 U/mL (Gla-100) with less hypoglycemia.^4,5

Researchers performed a post hoc patient-level meta-analysis using data from these 2 studies to assess the combination of DPP-4 inhibitor therapy with Gla-300 and to compare the efficacy and safety of Gla-300 and Gla-100 with or without concomitant DPP-4 inhibitor use in patients with type 2 diabetes over 6 months of treatment.¹

Of the 1689 participants randomly assigned for treatment in these studies, 107 patients in the Gla-300 group and 133 patients in the Gla-100 group received concomitant DPP-4 inhibitor therapy.

Reduction in glycated hemoglobin (HbA1c) over the 6-month treatment period was comparable in both groups, regardless of concomitant DPP-4 inhibitor use. Gla-300 was associated with less risk of hypoglycemia compared with Gla-100 both at night and at any time of day, irrespective of concomitant DPP-4 inhibitor use. The adverse event profile in the two groups was similar.

“In conclusion, the comparable glycemic control with lower hypoglycaemia risk with Gla-300 vs Gla-100 was observed irrespective of concomitant [DPP-4 inhibitor] use in this population of people with type 2 diabetes,” stated the investigators.¹ Thus, combination therapy with Gla-300 and DPP-4 inhibitors is efficacious and well tolerated.

Reference

Yale JF, Pettus JH, Brito-Sanfiel M, et al. The effect of concomitant DPPIVi use on glycaemic control and hypoglycaemia with insulin glargine 300 U/mL (Gla-300) versus insulin glargine 100 U/mL (Gla-100) in people with type 2 diabetes: A patient-level meta-analysis of EDITION 2 and 3. PLoS One. 2018;13:e0190579.

2. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015; 38:140-149.

3. Penfornis A, Bourdel-Marchasson I, Quere S, Dejager S. Real-life comparison of DPP4-inhibitors with conventional oral antidiabetics as add-on therapy to metformin in elderly patients with type 2 diabetes: the HYPOCRAS study. Diabetes Metab. 2012;38:550-557.

4. Bolli GB, Riddle MC, Bergenstal RM, et al; EDITION 3 study investigators. New insulin glargine 300 U/ml compared with glargine 100 U/ml in insulin-naive people with type 2 diabetes on oral glucose lowering drugs: a randomized controlled trial (EDITION 3). Diabetes Obes Metab. 2015;17:386-394.

5. Yki-Jarvinen H, Bergenstal R, Ziemen M, et al. New insulin glargine 300 units/mL versus glargine 100 units/mL in people with type 2 diabetes using oral agents and basal insulin: glucose control and hypoglycemia in a 6-month randomized controlled trial (EDITION 2). Diabetes Care. 2014;37:3235-3243.