Diabetes Metab J.  2015 Feb;39(1):74-81. 10.4093/dmj.2015.39.1.74.

Economic Impact of Combining Metformin with Dipeptidyl Peptidase-4 Inhibitors in Diabetic Patients with Renal Impairment in Spanish Patients

• Sicras-Mainar A
• Navarro-Artieda R

• KMID: 2280660
• DOI: http://doi.org/10.4093/dmj.2015.39.1.74

Abstract

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 > or =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 (euro 2,486 vs. euro 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.

Keyword

Cardiovascular events; Diabetes; Dipeptidyl-peptidase 4 inhibitors; Health care costs; Metabolic control; Renal impairment

MeSH Terms

Compliance
Dipeptidyl-Peptidase IV Inhibitors
Health Care Costs
Humans
Hypoglycemia
Hypoglycemic Agents
Male
Metformin*
Retrospective Studies
Dipeptidyl-Peptidase IV Inhibitors
Hypoglycemic Agents
Metformin

Figure

• 

  Fig. 1 Flow diagram of study patients. OOAD, other oral antidiabetics (including sulfonylureas and glitazones); DPP-4, dipeptidyl peptidase-4. aA total of 4,233 patients were excluded from the study: 978 received no drug treatment, 1,127 received other drug therapies (insulin: 663), 241 discontinued treatment, and 1,887 changed therapy during follow-up, bSix hundred fifty-five patients were lost to the study and 326 excluded for other reasons. The percentage distribution of patients who were excluded and lost was similar in the two study groups. Patients with renal impairment were 6.0% of diabetics, 16.5% of those treated and 28.1% of those receiving oral antidiabetic treatment.

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