Glycemic Outcomes Of Dapagliflozin, Glimepiride, And Sitagliptin As Add-On Therapy To Metformin In Patients With Type 2 Diabetes Mellitus: A Prospective Observational Study

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a metabolic disease marked with progressive entity that cannot be managed effectively without combination therapy. Compared to randomised trials, which allow control of efficacy data, there is a dearth of real-world comparative data on second-line agents.

Objectives: The aim is to compare glycemic outcomes between dapagliflozin, glimepiride and sitagliptin as an addition to metformin in patients with T2DM.

Methods: An observational, prospective study was commissioned in a tertiary care hospital during a period of 9 months. Patients with T2DM under treatment were included by selection and maintained based on the add-on therapy administered by their treating doctor: dapagliflozin (n=40), glimepiride (n=40) or sitagliptin (n=40). The first-order outcomes were the changes in glycated haemoglobin (HbA1c), blood sugar fasting (FBS), postprandial blood sugar (PPBS). ANOVA analyses were conducted with p<0.05 taken as significant.

Results: Baseline results showed that groups were similar in the following domains: age, sex, years of diabetes, and glycemic indices. HbA1c levels differed significantly 9 months post-intervention in all groups, with the dapagliflozin group showing the greatest (−1.7%, p< 0.001) drop, then sitagliptin (−1.3), and lastly glimepiride (−0.9). The same trend was observed in FBS and PPBS where the most significant improvements could be observed in dapagliflozin.

Conclusion: Dapagliflozin has been found to have better glycemic effects than glimepiride and sitagliptin as an add-on medication to metformin in the real-life setting. Sitagliptin had intermediate levels of benefits and good toleration whereas glimepiride was no weaker but of lesser effectiveness in the management of glucose. This evidence justifies patient-specific therapeutic choices depending on their efficacy and their safety, as well as the context of the patient.