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Original Articles
Glycemic Effectiveness of Metformin-Based Dual-Combination Therapies with Sulphonylurea, Pioglitazone, or DPP4-Inhibitor in Drug-Naïve Korean Type 2 Diabetic Patients
Young Ki Lee, Sun Ok Song, Kwang Joon Kim, Yongin Cho, Younjeong Choi, Yujung Yun, Byung-Wan Lee, Eun-Seok Kang, Bong Soo Cha, Hyun Chul Lee
Diabetes Metab J. 2013;37(6):465-474.   Published online December 12, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.6.465
  • 5,115 View
  • 67 Download
  • 17 Crossref
AbstractAbstract PDFPubReader   
Background

This study compared the glycemic effectiveness of three metformin-based dual therapies according to baseline hemoglobin A1c (HbA1c) to evaluate the appropriateness of the guideline enforced by the National Health Insurance Corporation of Korea for initial medication of type 2 diabetes (T2D).

Methods

This prospective observational study was conducted across 24 weeks for drug-naïve Korean T2D patients with HbA1c greater than 7.5%. Subjects were first divided into three groups based on the agent combined with metformin (group 1, gliclazide-modified release or glimepiride; group 2, pioglitazone; group 3, sitagliptin). Subjects were also classified into three categories according to baseline HbA1c (category I, 7.5%≤HbA1c<9.0%; category II, 9.0%≤HbA1c<11.0%; category III, 11.0%≤HbA1c).

Results

Among 116 subjects, 99 subjects completed the study, with 88 subjects maintaining the initial medication. While each of the metformin-based dual therapies showed a significant decrease in HbA1c (group 1, 8.9% to 6.4%; group 2, 9.0% to 6.6%; group 3, 9.3% to 6.3%; P<0.001 for each), there was no significant difference in the magnitude of HbA1c change among the groups. While the three HbA1c categories showed significantly different baseline HbA1c levels (8.2% vs. 9.9% vs. 11.9%; P<0.001), endpoint HbA1c was not different (6.4% vs. 6.6% vs. 6.0%; P=0.051).

Conclusion

The three dual therapies using a combination of metformin and either sulfonylurea, pioglitazone, or sitagliptin showed similar glycemic effectiveness among drug-naïve Korean T2D patients. In addition, these regimens were similarly effective across a wide range of baseline HbA1c levels.

Citations

Citations to this article as recorded by  
  • Benefits and risks of drug combination therapy for diabetes mellitus and its complications: a comprehensive review
    Xueqin Xie, Changchun Wu, Yuduo Hao, Tianyu Wang, Yuhe Yang, Peiling Cai, Yang Zhang, Jian Huang, Kejun Deng, Dan Yan, Hao Lin
    Frontiers in Endocrinology.2023;[Epub]     CrossRef
  • Estimation of Serum Creatinine, Aspartate Aminotransferase, Alanine Transaminase, and Hemoglobin A1c% Levels among Diabetic Patients using Metformin/Dipeptide Peptidase-4 Inhibitor Combination and Insulin – A Cross-Sectional Study
    Arshiya Shadab, Ilma Hussain, Praveen Kumar Kandakurti, Marwan Ismail, Ahmed Luay Osman Hashim, Salah Eldin Omar Hussein, Altoum Abd Elgadir
    Open Access Macedonian Journal of Medical Sciences.2022; 10(B): 959.     CrossRef
  • Acarbose Add-on Therapy in Patients with Type 2 Diabetes Mellitus with Metformin and Sitagliptin Failure: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study
    Hae Kyung Yang, Seung-Hwan Lee, Juyoung Shin, Yoon-Hee Choi, Yu-Bae Ahn, Byung-Wan Lee, Eun Jung Rhee, Kyung Wan Min, Kun-Ho Yoon
    Diabetes & Metabolism Journal.2019; 43(3): 287.     CrossRef
  • Initial combination therapy with vildagliptin plus metformin in drug-naïve patients with T2DM: a 24-week real-life study from Asia
    Manoj Chawla, Tae Ho Kim, Roberto C. Mirasol, Pathan Faruque, Kathryn Cooke, Peggy Hours-Zesiger, Abhijit Shete
    Current Medical Research and Opinion.2018; 34(9): 1605.     CrossRef
  • Consensus recommendations on sulfonylurea and sulfonylurea combinations in the management of Type 2 diabetes mellitus – International Task Force
    Sanjay Kalra, Silver Bahendeka, Rakesh Sahay, Sujoy Ghosh, Fariduddin Md, Abbas Orabi, Kaushik Ramaiya, Sameer Al Shammari, Dina Shrestha, Khalid Shaikh, Sachitha Abhayaratna, PradeepK Shrestha, Aravinthan Mahalingam, Mazen Askheta, AlyAhmed A. Rahim, Fat
    Indian Journal of Endocrinology and Metabolism.2018; 22(1): 132.     CrossRef
  • Efficacy and safety of sitagliptin/metformin fixed‐dose combination compared with glimepiride in patients with type 2 diabetes: A multicenter randomized double‐blind study
    Sang Soo Kim, In Joo Kim, Kwang Jae Lee, Jeong Hyun Park, Young Il Kim, Young Sil Lee, Sung Chang Chung, Sang Jin Lee
    Journal of Diabetes.2017; 9(4): 412.     CrossRef
  • Short‐term intensive insulin therapy could be the preferred option for new onset Type 2 diabetes mellitus patients with HbA1c > 9%
    Jianping Weng
    Journal of Diabetes.2017; 9(10): 890.     CrossRef
  • The efficacy and safety of adding either vildagliptin or glimepiride to ongoing metformin therapy in patients with type 2 diabetes mellitus
    Gyuri Kim, Sewon Oh, Sang-Man Jin, Kyu Yeon Hur, Jae Hyeon Kim, Moon-Kyu Lee
    Expert Opinion on Pharmacotherapy.2017; 18(12): 1179.     CrossRef
  • Effects of pioglitazone therapy on blood parameters, weight and BMI: a meta-analysis
    Elena Filipova, Katya Uzunova, Krassimir Kalinov, Toni Vekov
    Diabetology & Metabolic Syndrome.2017;[Epub]     CrossRef
  • Is insulin the preferred treatment for HbA1c >9%?
    Zachary Bloomgarden
    Journal of Diabetes.2017; 9(9): 814.     CrossRef
  • The effect of pioglitazone on weight, lipid profile and liver enzymes in type 2 diabetic patients
    Nasser Aghamohammadzadeh, Mitra Niafar, Elham Dalir Abdolahinia, Farzad Najafipour, Saeed Mohamadzadeh Gharebaghi, Khadijeh Adabi, Elaheh Dalir Abdolahinia, Hamidreza Ahadi
    Therapeutic Advances in Endocrinology and Metabolism.2015; 6(2): 56.     CrossRef
  • Glycated Albumin Levels in Patients with Type 2 Diabetes Increase Relative to HbA1cwith Time
    Hye-jin Yoon, Yong-ho Lee, Kwang Joon Kim, So Ra Kim, Eun Seok Kang, Bong-Soo Cha, Hyun Chul Lee, Byung-Wan Lee
    BioMed Research International.2015; 2015: 1.     CrossRef
  • Four-Year Durability of Initial Combination Therapy with Sitagliptin and Metformin in Patients with Type 2 Diabetes in Clinical Practice; COSMIC Study
    Eu Jeong Ku, Kyong Yeon Jung, Yoon Ji Kim, Kyoung Min Kim, Jae Hoon Moon, Sung Hee Choi, Young Min Cho, Kyong Soo Park, Hak Chul Jang, Soo Lim, Bo Ahrén, Giorgio Sesti
    PLOS ONE.2015; 10(6): e0129477.     CrossRef
  • Comparative analysis of therapeutic efficiency and costs (experience in Bulgaria) of oral antidiabetic therapies based on glitazones and gliptins
    Elena Pavlova Filipova, Katya Hristova Uzunova, Toni Yonkov Vekov
    Diabetology & Metabolic Syndrome.2015;[Epub]     CrossRef
  • Interactions of DPP-4 and integrin β1 influences endothelial-to-mesenchymal transition
    Sen Shi, Swayam Prakash Srivastava, Megumi Kanasaki, Jianhua He, Munehiro Kitada, Takako Nagai, Kyoko Nitta, Susumu Takagi, Keizo Kanasaki, Daisuke Koya
    Kidney International.2015; 88(3): 479.     CrossRef
  • Sodium Glucose Co-transporter 2 (SGLT2) Inhibitors: New among Antidiabetic Drugs
    L. H. Opie
    Cardiovascular Drugs and Therapy.2014; 28(4): 331.     CrossRef
  • Metformin Based Dual-Combination Therapies in Drug Naïve Type 2 Diabetic Patients
    Dong-Lim Kim
    Diabetes & Metabolism Journal.2013; 37(6): 429.     CrossRef
Glycemic Effects of Once-a-Day Rapid-Acting Insulin Analogue Addition on a Basal Insulin Analogue in Korean Subjects with Poorly Controlled Type 2 Diabetes Mellitus
Eun Yeong Choe, Yong-ho Lee, Byung-Wan Lee, Eun-Seok Kang, Bong Soo Cha, Hyun Chul Lee
Diabetes Metab J. 2012;36(3):230-236.   Published online June 14, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.3.230
  • 3,082 View
  • 32 Download
  • 5 Crossref
AbstractAbstract PDFPubReader   
Background

The present study investigates the efficacy in glycemic control by adding once-a-day glulisine to glargine as a basal plus regimen and factors influencing glycemic control with the basal plus regimen in Korean subjects with type 2 diabetes.

Methods

In the present retrospective study, subjects previously treated with the basal plus regimens for at least 6 months were reviewed. Changes in glycemic profiles and clinical parameters were evaluated.

Results

A total of 87 subjects were ultimately enrolled in this study. At baseline, mean glycated hemoglobin (A1c) and glycated albumin were 8.5% (8.0% to 9.6%) and 25.2±7.6%, respectively. After treatment with the basal plus regimen, patients had significant reductions of A1c at 6 months (0.8±0.1%, P<0.001) and their postprandial glucose levels were decreased by 48.7±10.3 mg/dL (P<0.001). Multiple logistic regression showed old age (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.02 to 1.55), high initial A1c (OR, 22.21; 95% CI, 2.44 to 201.78), and lower amounts of glargine (OR, 0.85; 95% CI, 0.76 to 0.99), and glimepiride (OR, 0.23; 95% CI, 0.06 to 0.93) at baseline were independently associated with good responders whose A1c reduction was more than 0.5%.

Conclusion

The authors suggest a basal plus regimen may be effective in reducing glucose levels of subjects with old age, high initial A1c, and patients on low doses of glimepiride and glargine. Despite the use of high doses of hypoglycemic agents, elderly patients with poorly-controlled diabetes are preferred for early initiation of the basal plus regimen.

Citations

Citations to this article as recorded by  
  • Titration of basal insulin or immediate addition of rapid acting insulin in patients not at target using basal insulin supported oral antidiabetic treatment – A prospective observational study in 2202 patients
    Thorsten Siegmund, Martin Pfohl, Thomas Forst, Stefan Pscherer, Peter Bramlage, Johannes Foersch, Anja Borck, Jochen Seufert
    Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2017; 11(1): 51.     CrossRef
  • Characteristics Predictive for a Successful Switch from Insulin Analogue Therapy to Oral Hypoglycemic Agents in Patients with Type 2 Diabetes
    Gyuri Kim, Yong-ho Lee, Eun Seok Kang, Bong-Soo Cha, Hyun Chul Lee, Byung-Wan Lee
    Yonsei Medical Journal.2016; 57(6): 1395.     CrossRef
  • Clinical Characteristics of Patients Responding to Once-Daily Basal Insulin Therapy in Korean Subjects with Type 2 Diabetes
    Sun Ok Song, You-Cheol Hwang, Kyu-Jeung Ahn, Bong Soo Cha, Young Duk Song, Dae Wook Lee, Byung-Wan Lee
    Diabetes Therapy.2015; 6(4): 547.     CrossRef
  • The optimal morning:evening ratio in total dose of twice‐daily biphasic insulin analogue in poorly controlled Type 2 diabetes: a 24‐week multi‐centre prospective, randomized controlled, open‐labelled clinical study
    C. H. Jung, J.‐Y. Park, J. H. Cho, K.‐H. Yoon, H. K. Yang, Y.‐H. Lee, B. S. Cha, B.‐W. Lee
    Diabetic Medicine.2014; 31(1): 68.     CrossRef
  • The glycemic efficacies of insulin analogue regimens according to baseline glycemic status in Korean patients with type 2 diabetes: sub‐analysis from the A 1 chieve ® study
    Y.‐C. Hwang, J. G. Kang, K. J. Ahn, B. S. Cha, S.‐H. Ihm, S. Lee, M. Kim, B.‐W. Lee
    International Journal of Clinical Practice.2014; 68(11): 1338.     CrossRef

Diabetes Metab J : Diabetes & Metabolism Journal