Canagliflozin vs Glimepiride: Which is Best for Glycemic Control?

Patients with type 2 diabetes and on background metformin saw greater reductions in HbA_1c levels when adding canagliflozin, a sodium-glucose co-transporter 2 inhibitor, than those who added glimepiride. Those taking canagliflozin also had fewer episodes of hypoglycemia than those taking glimepiride.

Type 2 diabetes guidelines recommend the lowering of HbA_1c levels to <6.5% or <7.0% for most patients, as long as the levels can be achieved while avoiding hypoglycemia.
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For their post hoc analysis, researchers examined data from 1450 participants with type 2 diabetes, with average HbA_1c levels of 7.8% and average body mass index of 31.0 kg/m².  The participants were randomly assigned to either canagliflozin 100 or 300 mg or to glimepiride, titrated to maximum tolerated dose (mean maximum dose of 5.6 mg/d).

At 52 weeks, 100 mg of canagliflozin was non-inferior to glimepiride, and canagliflozin 300 mg was superior to glimepiride in its ability to lower HbA_1c levels, although the proportion of patients achieving target HbA_1c levels was similar across all 3 groups. However, the incidence of hypoglycemia was significantly lower with canagliflozin than with glimepiride.

“In a 52-week, phase 3 study of patients with [type 2 diabetes] on background metformin, canagliflozin, a sodium glucose co-transporter 2 inhibitor, improved glycemic control and reduced body weight with fewer episodes of hypoglycemia versus glimepiride,” the researchers concluded.

—Michael Potts

Reference:
Davies M, Merton K, Vijapurkar U, et al. Achievement of glycemic goals without hypoglycemia with canagliflozin versus glimepiride in patients with type 2 diabetes mellitus [abstract 302]. Endocr Pract. 2016;22(suppl 2):86. http://am.aace.com/sites/all/files/AbstractBook-2016_ALL.pdf. Accessed June 3, 2016.