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Dapagliflozin Plus Saxagliptin Add-on Therapy Compared With Insulin in Patients With Type 2 Diabetes Poorly Controlled by Metformin With or Without Sulfonylurea Therapy: A Randomized Clinical Trial

Artikel i vetenskaplig tidskrift
Författare T. Vilsboll
E. Ekholm
E. Johnsson
N. Dronamraju
S. Jabbour
Marcus Lind
Publicerad i Diabetes Care
Volym 42
Nummer/häfte 8
Sidor 1464-1472
ISSN 0149-5992
Publiceringsår 2019
Publicerad vid Institutionen för medicin
Sidor 1464-1472
Språk en
Länkar dx.doi.org/10.2337/dc18-1988
Ämnesord inadequate glycemic control, glucose-lowering drugs, double-blind, cvd-real, management, inhibitors, hyperglycemia, association, monotherapy, statement, Endocrinology & Metabolism
Ämneskategorier Endokrinologi och diabetes

Sammanfattning

OBJECTIVE This study evaluated whether an oral combination of a sodium-glucose cotransporter 2 inhibitor and a dipeptidyl peptidase 4 inhibitor achieved glycemic control similar to basal insulin in patients with type 2 diabetes, poorly controlled with metformin, without increasing hypoglycemia or body weight. RESEARCH DESIGN AND METHODS In a multinational, open-label, randomized, phase 3 trial ( reg. no. ), adults with type 2 diabetes inadequately controlled on metformin, with or without sulfonylurea, were randomized (1:1) to receive dapagliflozin (DAPA) plus saxagliptin (SAXA) or titrated insulin glargine (INS). The primary end point was change in glycated hemoglobin A(1c) (HbA(1c)) from baseline to week 24. DAPA + SAXA treatment was tested for noninferiority versus INS. RESULTS The efficacy data set included 643 patients (mean +/- SD HbA(1c), 9.1 +/- 1.0% [75 +/- 11 mmol/mol]). At week 24, DAPA + SAXA treatment versus INS resulted in noninferior reductions in HbA(1c) (adjusted mean +/- SE change, -1.7 +/- 0.1% vs. -1.5 +/- 0.1% [18.3 +/- 0.7 mmol/mol vs. 16.8 +/- 0.7 mmol/mol]; P = 0.118), significantly different body weight change (between-group difference, -3.64 kg [95% CI -4.20 to -3.09]; P < 0.001), fewer patients with confirmed hypoglycemia (21.3% vs. 38.4%, P < 0.001), more patients achieving HbA(1c) <7.0% (53 mmol/mol) without hypoglycemia (20.9% vs. 13.1%, P = 0.008), and a similar proportion of patients achieving HbA(1c) <7.0% (33.2% vs. 33.5%, P = 0.924). Mean reductions in 24-h glucose measurements from baseline to week 2 were greater with DAPA + SAXA than with INS (P < 0.0001). No patients in the DAPA + SAXA group and three patients (0.9%) in the INS group experienced severe hypoglycemia. CONCLUSIONS Adding DAPA + SAXA to insulin-naive patients with poorly controlled type 2 diabetes achieved similar glycemic control, a lower risk of hypoglycemia, and a clinically relevant body weight difference compared with basal INS.

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