Endocrine Abstracts (2013) 32 P480 | DOI: 10.1530/endoabs.32.P480

The long term effect of metformin plus DPP-4 inhibitor switching from metformin plus pioglitazone combination therapy in type 2 diabetes

Yonghyun Kim & Donghyun Shin

Endocrinology Division, Internal Medicine, Bundang Jesaeng Hospital, Seongnam, Republic of Korea.

Two years ago, we presented the short term 6 month results of metformin plus DPP-4 inhibitor combination therapy when we can’t reach the target below 7% of HgA1c with metformin plus pioglitazone combination that is best in terms of relieving insulin resistance in early diabetes.

Switching the pioglitazone to the DPP-4 inhibitor that improves insulin secretory dysfunction can be the next useful step to attain glucose control goal and DPP-4 inhibitors that increase insulin secretion by glucose dependent manner can also relieve insulin resistance because they improve first phase insulin secretion defect and prevent late hyperinsulinemia. DPP-4 inhibitor is also better than pioglitazone in weight aspect.

Total 111 patients were followed by 26.5 month (±9.7) after switching from metformin plus pioglitazone.

Sulfonylurea or pioglitazone was added for adequate glucose control in 14% (15/111) and the dose of DPP-4 inhibitor was decreased in 6% (7/111). The mean increasing dose of metformin to maintain HgA1c target who maintained metformin plus first dose of DPP-4 inhibitor in 80% (89/111) was 260 mg in the end.

HgA1c was improved in 76% (68 of 89 who maintained metformin plus first dose of DPP-4 inhibitor) from 7.40 to 6.66% and the metformin dose was increased by 240 mg. HgA1c was aggravated in 22% (20/89) from 6.85 to 7.22%.

HOMA-IR was improved in 46% (0.91±0.92) and aggravated in 53% (−1.25±1.17). Mean HOMA-IR change was −0.24±1.51.

Mena weight reduction was 2.23 kg (±3.17). The weight was decreased in 72% (3.63±2.51) and increased in 19% (1.77±1.73).

Although dose of metformin was slightly increased to maintain glucose control target with time, metformin plus DPP-4 inhibitor can be a good treatment option in maintaining insulin resistance as well as glucose and weight control as compared to Metformin plus pioglitazone therapy.

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