SGLT2i–DPP-4i combo boosts glycaemic control in T2DM

The combination of sodium-glucose co-transporter-2 (SGLT2i) and dipeptidyl peptidase-4 (DPP-4i) inhibitors cuts postprandial hyperglycaemia and improves the quality of glycaemic variability, as opposed to monotherapy with either agent, reports a new study.

The present study was a secondary analysis of the CALMER study, which randomized type 2 diabetes mellitus (T2DM) patients (mean age, 62.3 years; 61.6 percent male) to either switch from teneligliptin to canagliflozin, or to combine the latter agent to the former. Ninety-nine patients participated and were subjected to continuous glucose monitoring.

Patients who took the combination treatment saw a significantly larger decrease in mean blood glucose (MBG) than their counterparts who switched medications instead (–22.3 vs –10.6 mg/dL; p<0.01). Similarly, the time per day above the target range dropped to a greater degree in the former group (–14.8 percent vs –7.5 percent; p<0.01).

Moreover, the combination treatment also significantly improved time in target range (TIR; 71.2 percent to 82.7 percent; p<0.001). The magnitude of change, however, did not differ relative to the switch group.

Receiver operating characteristic analysis found that beyond a baseline MBG value of 145.4 mg/dL, the combination of both SGLT2i and DPP-4i would lead to an improvement in TIR. The resulting area under the curve was 0.93, with sensitivity and specificity values of 73.5 percent and 100.0 percent, respectively.

The findings “indicate that adding SGLT2i to DPP-4i in T2DM patients with a higher level of baseline MBG may lead to greater effects on increasing TIR. The combination therapy could be a crucial strategy for patients with T2DM who are at high risk of diabetic complications,” the researchers said.