Sitagliptin Vs. Pioglitazone As Add-On Treatments in Patients With Uncontrolled Type 2 Diabetes on the Maximal Dose of Metformin Plus Sulfonylurea Publisher Pubmed



Khaloo P¹ ; Asadi Komeleh S¹ ; Alemi H¹ ; Mansournia MA² ; Mohammadi A¹ ; Yadegar A¹ ; Afarideh M¹ ; Esteghamati S¹ ; Nakhjavani M¹ ; Esteghamati A¹ Show Affiliations
Source: Journal of Endocrinological Investigation Published:2019

Abstract

Aims: To compare the efficacy of sitagliptin versus pioglitazone as add-on drugs in patients with poorly controlled diabetes with metformin and sulfonylureas. Methods: This is a randomized, open-label, parallel assignment clinical trial. Patients who had inadequate glycemic control [7% (53 mmol/mol) ≤ A1C < 11% (97 mmol/mol)] despite a minimum 6-month period of active treatment with metformin 2000 mg/day plus gliclazide 240 mg/day were enrolled in the study. HbA1C, fasting blood glucose (FBG), fasting plasma lipid parameters [total cholesterol (TC0, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C)], systolic and diastolic blood pressure (SBP, DBP), weight, waist circumference, and body mass index were measured at baseline and after 17, 34, and 52 weeks of treatment. Generalized estimating equation analysis was done to compare treatment groups for continuous efficacy parameters. Results: No significant difference in HbA1C reduction was observed between the treatment groups during the study course. (P = 0.149, adjusted P = 0.434; coefficient − 0.11 ± 0.08). The FBG (P = 0.032; coefficient 7.44 ± 3.48), HDL-C (P = 0.001; coefficient − 2.69 ± 0.83), TG (P = 0.027; coefficient 12.63 ± 5.71) and SBP (P < 0.001; coefficient 5.43 ± 1.26) changes from baseline, and weight gain were greater in the pioglitazone group. The mean changes in LDL-C and TC from baseline to week 52 were greater in the sitagliptin group (P = 0.034; coefficient − 7.40 ± 3.50, P = 0.013; coefficient − 7.16 ± 2.88, respectively). Conclusion: Sitagliptin and pioglitazone were equally effective in improvement of HbA1C. There were some differences in terms of lipid indices, weight gain, and SBP. The current study confirmed that both sitagliptin and pioglitazone are effective treatment options and the decision should be made for each individual based on the baseline characteristics. © 2018, Italian Society of Endocrinology (SIE).