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- Economic Impact of Combining Metformin with Dipeptidyl Peptidase-4 Inhibitors in Diabetic Patients with Renal Impairment in Spanish Patients
- Antoni Sicras-Mainar, Ruth Navarro-Artieda
- Diabetes Metab J. 2015;39(1):74-81. Published online February 16, 2015
- DOI: https://doi.org/10.4093/dmj.2015.39.1.74
- 3,385 View
- 26 Download
- 3 Web of Science
- 4 Crossref
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Abstract
PDF
PubReader Background To evaluate resource use and health costs due to the combination of metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with diabetes and renal impairment in routine clinical practice.
Methods An observational, retrospective study was performed. Patients aged ≥30 years treated with metformin who initiated a second oral antidiabetic treatment in 2009 to 2010 were included. Two groups of patients were analysed: metformin+DPP-4 inhibitors and other oral antidiabetics. The main measures were: compliance, persistence, metabolic control (glycosylated hemoglobin< 7%) and complications (hypoglycemia, cardiovascular events) and total costs. Patients were followed up for 2 years.
Results We included 395 patients, mean age 70.2 years, 56.5% male: 135 patients received metformin+DPP-4 inhibitors and 260 patients received metformin+other oral antidiabetics. Patients receiving DPP-4 inhibitors showed better compliance (66.0% vs. 60.1%), persistence (57.6% vs. 50.0%), and metabolic control (63.9% vs. 57.3%), respectively, compared with those receiving other oral antidiabetics (
P <0.05), and also had a lower rate of hypoglycemia (20.0% vs. 47.7%) and lower total costs (€ 2,486 vs. € 3,002),P =0.001.Conclusion Despite the limitations of the study, patients with renal impairment treated with DPP-4 inhibitors had better metabolic control, lower rates (association) of hypoglycaemia, and lower health costs for the Spanish national health system.
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Citations
Citations to this article as recorded by
- Characteristics of Hypoglycemia Pateints Visiting the Emergency Department of a University Hospital
Sang-Hyeon Choi, Deok-Ki Youn, Moon-Gi Choi, Ohk-Hyun Ryu
The Journal of Korean Diabetes.2016; 17(3): 202. CrossRef - Response: Economic Impact of Combining Metformin with Dipeptidyl Peptidase-4 Inhibitors in Diabetic Patients with Renal Impairment in Spanish Patients (Diabetes Metab J2015;39:74-81)
Antoni Sicras-Mainar, Ruth Navarro-Artieda
Diabetes & Metabolism Journal.2015; 39(2): 173. CrossRef - Dipeptidyl Peptidase 4: A New Link between Diabetes Mellitus and Atherosclerosis?
Wellington Santana da Silva Júnior, Amélio Fernando de Godoy-Matos, Luiz Guilherme Kraemer-Aguiar
BioMed Research International.2015; 2015: 1. CrossRef - Letter: Economic Impact of Combining Metformin with Dipeptidyl Peptidase-4 Inhibitors in Diabetic Patients with Renal Impairment in Spanish Patients (Diabetes Metab J2015;39:74-81)
Hannah Seok
Diabetes & Metabolism Journal.2015; 39(2): 171. CrossRef
- Characteristics of Hypoglycemia Pateints Visiting the Emergency Department of a University Hospital
- Relationship between C-peptide, Metabolic Control and Chronic Complications in Type 2 Diabetes.
- Jeung Mook Kang, Won Young Lee, Ji Youn Kim, Jung Won Yun, Sun Woo Kim
- Korean Diabetes J. 2002;26(6):490-499. Published online December 1, 2002
- 1,082 View
- 19 Download
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Abstract
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- BACKGROUND
Type 2 diabetes mellitus is a heterogeneous disease characterized by variable degrees of insulin resistance, impaired insulin secretion and increased glucose production. As the decline of beta-cell function in type 2 diabetes is very slow, the relationship between the insulin secretory capacity, the degree of metabolic control and chronic complications is still unclear. The determination of plasma C-peptide allows for the assessment of the endogenous insulin production, even in the presence of exogenous insulin administration. The aim of this study was to evaluate the relationship between the serum C-peptide level and metabolic parameters, and the complications in type 2 diabetes. METHOD: The clinical characteristics and laboratory findings, such as lipid profile, fasting plasma glucose, HbA1C and uric acid, were evaluated, and their relationships with chronic complications analyzed. We measured the serum C-peptide level by radioimmunoassay (RIA) in 384 type 2 diabetes mellitus patients. The patients were divided into quartile groups according to their fasting C-peptide levels (quartile 1: <1.73 ng/mL, n=95; quartile 2:>or=1.73 ng/mL and <2.38 ng/mL, n=95; quartile 3:>or=2.38 ng/mL and <3.18 ng/mL, n=98; quartile 4:>or=3.18 ng/mL, n=96). RESULTS: Patients in the lowest C-peptide quartile showed significantly higher durations of diabetes, HbA1C and postprandial plasma glucose values, and HDL-cholesterol. Conversely, the BMI, systolic blood pressure, total cholesterol and triglyceride were significantly higher in the highest C-peptide quartile. The prevalence of diabetic retinopathy and urinary protein excretion were higher in lowest quartile, and the diastolic blood pressure was highest in the upper quartile, but these were not statistically significant. The associations between C-peptide, and the duration of diabetes, BMI, total cholesterol, triglyceride, HDL cholesterol, postprandial 2 plasma glucose and systolic blood pressure remained significant, even after multiple adjustments. CONCLUSION: In type 2 diabetes, higher C-peptide levels are associated with a component of metabolic syndrome and lower C-peptide levels due to decreased cell reserves, associated with hyperglycemia and microvascular complications
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