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Endocrine Abstracts (2023) 90 EP1105 | DOI: 10.1530/endoabs.90.EP1105

ECE2023 Eposter Presentations Late Breaking (91 abstracts)

Rechallenge with a single-pill combination of sitagliptin plus extended-release metformin in patients labelled as metformin-intolerant: Mostly successful

Francisco Javier Martinez Martin 1,2 , Carlos Rios-Gomez 1 , Borja Santana-Ojeda 1 , Ricardo Jose de Leon-Durango 1 , Alba Hernandez-Lazaro 1 , Claudia Arnas-Leon 1,2 , Carmen Acosta-Calero 3 , Agnieszka Kuzior 2 , Paula Gonzalez-Diaz 4 & Paula Maria Fernandez-Trujillo-Comenge 1

1University Hospital of Gran Canaria Dr. Negrín, Endocrinology & Nutrition, Las Palmas de Gran Canaria, Spain, 2Clinica San Roque, Endocrinology & Nutrition, Las Palmas de Gran Canaria, Spain, 3University Hospital of Gran Canaria Dr. Negrín, Cardiology, Las Palmas de Gran Canaria, Spain, 4University Hospital of Gran Canaria Dr. Negrín, Emergency Medicine, Las Palmas de Gran Canaria, Spain

Introduction: Extended-release (ER) metformin has been available in many countries for the last two decades, and it may have definite advantages vs. conventional (i.e., immediate-release) metformin: Reportedly, it may reduce gastrointestinal adverse effects by about half, thus increasing compliance; moreover, the once-a-day schedule may contribute to increased adherence and persistence, and hopefully improved outcomes. However, ER metformin was unavailable in Spain until 2022: when generic sitagliptin became available, a single-pill combination containing 50 mg sitagliptin and 1000 mg ER metformin was released, while monocomponent ER metformin is still unavailable. We undertook to rechallenge metformin-intolerant T2DM patients treated with a DPP4 inhibitor with the sitagliptin plus ER metformin single-pill combination in order to assess its tolerability and efficacy.

Methods: T2DM patients with HbA1c >7% and GFR (CKD-EPI) >45 mL/min/1.73m2, labelled as metformin-intolerant due to gastrointestinal symptoms, and treated with a DPP4 inhibitor (with or without additional hypoglycemic medication) were switched to the 50 mg sitagliptin plus 1000 mg ER metformin single-pill combination, taking 1 pill with the evening meal in the first month and afterwards 2 pills together if the tolerance was good. Additional medication, if any, was unchanged. Data on glycemic control were compared (paired t-test) between the baseline visit and a follow-up visit 3-4 months afterwards. Tolerance data were obtained by questionnaire in the follow-up visit. All patients included gave informed consent. Data are given as mean±sd.

Results: 38 patients were included, 24 (63%) were women, age 55±8 years, diabetes duration 7±3 years. 32 (84%) tolerated 1 pill, although 12 of them (32% of the total) had minor gastrointestinal symptoms which subsided along the first month and did not cause withdrawal. 27 (71%) of the patients tolerated 2 pills, although 7 of them (18% of the total) had minor symptoms after the dose increase. Fasting plasma glucose was reduced from 178±38 mg/dl to 139±26 mg/dl (P< 0.001) in those who tolerated 1 pill, and to 128±19 (P< 0.001) in those who tolerated 2 pills. HbA1c was reduced from 8.2±1.1% to 7.8±0.8% (P=0.058, 1 pill) and 7.6±0.7% (P=0.015, 2 pills). Of 11 patients who did not tolerate the rechallenge, 8 (21%) reported diarrhea, 4 (11%) flatulence, 2 (5%) abdominal pain, 2 (5%) nausea and 1 (3%) dyspepsia.

Conclusions: Rechallenge with ER metformin plus sitagliptin in patients intolerant to conventional metformin was mostly successful, with 5/6 tolerating 1 pill and 7/10 full dose. Side effects were minor, and glycemic control was improved.

Volume 90

25th European Congress of Endocrinology

Istanbul, Turkey
13 May 2023 - 16 May 2023

European Society of Endocrinology 

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