Diabetes Metab J.  2023 Jan;47(1):135-139. 10.4093/dmj.2021.0373.

The Efficacy of Treatment Intensification by Quadruple Oral Therapy Compared to GLP-1RA Therapy in Poorly Controlled Type 2 Diabetes Mellitus Patients: A Real-world Data Study

Affiliations
  • 1Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
  • 2Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
  • 3Institute of Health Science, Gyeongsang National University, Jinju, Korea

Abstract

We compared the glycemic efficacy of treatment intensification between quadruple oral antidiabetic drug therapy and once-weekly glucagon-like peptide-1 receptor agonist (GLP-1RA)-based triple therapy in patients with poorly controlled type 2 diabetes mellitus refractory to triple oral therapy. For 24 weeks, changes in glycosylated hemoglobin (HbA1c) from baseline were compared between the two treatment groups. Of all 96 patients, 50 patients were treated with quadruple therapy, and 46 were treated with GLP-1RA therapy. Reductions in HbA1c for 24 weeks were comparable (in both, 1.1% reduction from baseline; P=0.59). Meanwhile, lower C-peptide level was associated with a lower glucose-lowering response of GLP-1RA therapy (R=0.3, P=0.04) but not with quadruple therapy (R=–0.13, P=0.40). HbA1c reduction by GLP-1RA therapy was inferior to that by quadruple therapy in the low C-peptide subgroup (mean, –0.1% vs. –1.3%; P=0.04). Treatment intensification by switching to quadruple oral therapy showed similar glucose-lowering efficacy to weekly GLP-1RA-based triple therapy. Meanwhile, the therapeutic response was affected by C-peptide levels in the GLP-1RA therapy group but not in the quadruple therapy group.

Keyword

Dapagliflozin; Diabetes mellitus, type 2; Dulaglutide; Drug combinations; Empagliflozin; Thiazolidinediones; Treatment outcome

Figure

  • Fig. 1. Changes in glycosylated hemoglobin (HbA1c) for 24 weeks according to baseline C-peptide levels in each treatment group. Data are presented as mean±standard error. GLP-1RA, glucagon-like peptide-1 receptor agonist.


Reference

1. Fonseca VA. Defining and characterizing the progression of type 2 diabetes. Diabetes Care. 2009; 32 Suppl 2:S151–6.
Article
2. Desai U, Kirson NY, Kim J, Khunti K, King S, Trieschman E, et al. Time to treatment intensification after monotherapy failure and its association with subsequent glycemic control among 93,515 patients with type 2 diabetes. Diabetes Care. 2018; 41:2096–104.
Article
3. Hur KY, Moon MK, Park JS, Kim SK, Lee SH, Yun JS, et al. 2021 Clinical practice guidelines for diabetes mellitus of the Korean Diabetes Association. Diabetes Metab J. 2021; 45:461–81.
Article
4. Aronson R. The role of comfort and discomfort in insulin therapy. Diabetes Technol Ther. 2012; 14:741–7.
Article
5. Brod M, Kongso JH, Lessard S, Christensen TL. Psychological insulin resistance: patient beliefs and implications for diabetes management. Qual Life Res. 2009; 18:23–32.
Article
6. Ku EJ, Lee DH, Jeon HJ, Oh TK. Effectiveness and safety of empagliflozin-based quadruple therapy compared with insulin glargine-based therapy in patients with inadequately controlled type 2 diabetes: an observational study in clinical practice. Diabetes Obes Metab. 2019; 21:173–7.
Article
7. Moon JS, Suh S, Kim SS, Jin HY, Kim JM, Jang MH, et al. Efficacy and safety of treatment with quadruple oral hypoglycemic agents in uncontrolled type 2 diabetes mellitus: a multi-center, retrospective, observational study. Diabetes Metab J. 2021; 45:675–83.
8. Jeon HJ, Ku EJ, Oh TK. Dapagliflozin improves blood glucose in diabetes on triple oral hypoglycemic agents having inadequate glucose control. Diabetes Res Clin Pract. 2018; 142:188–94.
Article
9. Zhang L, Zhang M, Zhang Y, Tong N. Efficacy and safety of dulaglutide in patients with type 2 diabetes: a meta-analysis and systematic review. Sci Rep. 2016; 6:18904.
Article
10. Jones AG, McDonald TJ, Shields BM, Hill AV, Hyde CJ, Knight BA, et al. Markers of β-cell failure predict poor glycemic response to GLP-1 receptor agonist therapy in type 2 diabetes. Diabetes Care. 2016; 39:250–7.
Article
11. Thong KY, McDonald TJ, Hattersley AT, Blann AD, Ramtoola S, Duncan C, et al. The association between postprandial urinary C-peptide creatinine ratio and the treatment response to liraglutide: a multi-centre observational study. Diabet Med. 2014; 31:403–11.
Article
12. Leighton E, Sainsbury CA, Jones GC. A practical review of C-peptide testing in diabetes. Diabetes Ther. 2017; 8:475–87.
Article
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