Estudio sobre los resultados de la adición de una sulfonilurea, un inhibidor de la dipeptidil peptidasa 4 (IDPP-4) o un inhibidor del cotransportador sodio-glucosa tipo 2 (ISGLT-2) como segundo antidiabético en pacientes con DM2 en tratamiento con metformina e insuficiente control glucémicoestudio eControl Met+

Abstract

In clinical practice, adding a second antidiabetic drug to metformin treatment is very common to improve glycemic control and reduce the risks of cardiovascular and renal disease among patients with type 2 diabetes mellitus. Dipeptidyl-4 peptide inhibitors (DPP -4i), sodium-glucose co-transporter type 2 (SGLT2i) inhibitors, and sulfonylureas (SU) are the three-drug classes most often combined with metformin. The objective of the eControl Met+ study was to compare the efficacy, adherence, and safety data after the addition of DPP-4i, SGLT-2i, or SU to metformin under routine clinical practice conditions. Additionally, an analysis was performed to compare cardiovascular safety and mortality among users who started treatment with iSGLT-2 versus another antidiabetic treatment. Included subjects were matched for clinically relevant baseline characteristics for each analysis. The data source was the database (SIDIAP) that records all pathologies, diagnostic tests and treatments of people treated at the Primary Care centres of the Catalan Institute of Health. The proportion of patients who achieved the combined reduction in HbA1c (≥0.5%) and weight (≥3%) after the addition of DPP-4i, SGLT-2i, or SU was: 23.3%, 40.2% and 14.7%, respectively. SGLT-2i users were 1.7 times more likely to achieve good adherence than DPP-4i users and 2.8 times more likely than SU users. No differences were observed for adverse events between the treatment groups. The use of SGLT2i was associated with a lower risk of heart failure (HR: 0.59, 95% confidence interval [CI]: 0.47;0.74, p<0.001), all-cause mortality (HR=0 .41, 95% CI: 0.31; 0.54, p<0.001), or a combination of the two events (HR=0.55, 95% CI: 0.47;0.63, p<0.001). Persons who initiated treatment with an SGLT-2i in combination with metformin achieved better results for the objective weight reduction and HbA1c and had better adherence to treatment compared to the rest of the groups. Initiation of antidiabetic treatment with SGLT-2i was associated with a lower risk of serious events.