Combination Therapy Is Safe, Effective for Managing Type 2 Diabetes
Sodium glucose cotransporter 2 (SGLT2) inhibitor and dipeptidyl peptidase-4 (DPP-4) inhibitor combination therapy is a safe and effective alternative for some type 2 diabetes patients, according to a recent literature review.
The combination therapy is likely well suited for patients who are refractory to metformin therapy, who cannot obtain adequate glycemic control with metformin, or who have higher hemoglobinA1c (HbA1c) levels at baseline, the researchers said.
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In their review, the researchers evaluated single-pill and fixed-dose combinations of SGLT2 inhibitors and DPP-4 inhibitors that are available in the United States.
Results of the review indicated that SGLT2 inhibitors and DPP-4 inhibitors have complementary functions that can address several underlying pathophysiologic abnormalities in diabetes patients without overlapping toxicities. The researchers observed several benefits in combining SGLT2 and DPP-4 inhibitors, such as the ability to lower risk of hypoglycemia, the potential for weight loss, the ability to co-formulate into a once-daily pill, and the possibility of use with other agents that help lower glucose.
In addition, previous cardiovascular outcomes trials have supported the safety of the DPP-4 class and have indicated that SGLT2 may even have cardioprotective effects. These findings are based on the first-ever study that used empagliflozin.
Ultimately, the researchers found that treating type 2 diabetes with SGLT2 inhibitor and DPP-4 inhibitor therapy is effective and well supported by recent clinical evidence. When added to metformin, the combination can provide glycated HbA1c reductions of 1.1% to 1.5%, and weight reductions of about 4.5 lbs.
“The combination of an SGLT2 inhibitor/DPP-4 inhibitor is a safe and effective treatment choice for patients with [type 2 diabetes mellitus] who are unable to obtain adequate glycemic control with metformin therapy, cannot use metformin, or have a higher baseline HbA1c,” the researchers concluded.
—Christina Vogt
Reference:
Lingvay I. Sodium glucose cotransporter 2 and dipeptidyl peptidase-4 inhibition: promise of a dynamic duo. Endocr Pract. 2017;23(7):831-840. doi:10.4158/EP161725.RA.