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Evidence building for earlier use of gliptins

By Lilian Anekwe

Momentum appears to be building behind earlier use of gliptins in patients with type 2 diabetes, after a new study found benefits as part of initial combination therapy.

Research presented at last week's American Diabetes Association conference found patients with type 2 diabetes who begin initial therapy with sitagliptin and metformin had significantly better glycaemic control than those prescribed pioglitazone.

The single-pill combination of sitagliptin and metformin was granted a licence in the UK last month, but it is still not licensed as an initial therapy.

NICE recommends sitagliptin and vildagliptin as alternatives to sulfonylureas and glitazones as second-line treatments after metformin, saying gliptins or a glitazone should be considered ‘if there is a significant risk of hypoglycaemia', or in case of intolerance or contraindication.

US researchers randomised 517 patients to initial treatment with a sitagliptin 50mg and metformin 1,000mg combination twice a day, or pioglitazone 45mg daily. Patients were uptitrated to the final dose over four weeks.

From a mean baseline HbA1c of 8.9%, mean reductions were 1.9% in patients on the sitagliptin combination and 1.4% in the comparison group, a statistically significant difference.

Patients on the combination lost an average of 1.4kg but those on pioglitazone gained an average of 3kg. But nearly twice as many patients on combination therapy experienced hypoglycaemia – just short of statistical significance.

Professor Anthony Barnett, professor of diabetes at the heart of England NHS Foundation Trust, said: ‘This study shows newer treatments, such as sitagliptin or the combination of sitagliptin and metformin, may provide advantages over some more traditional treatments, particularly a lower risk of weight gain.'

Evidence building for earlier use of gliptins