Effectiveness of second-line agents in the treatment of uncomplicated type 2 diabetes mellitus

An observational tertiary-care based study

Research output: Contribution to journalArticle

Abstract

Background: The rational prescribing of second-line drugs in type 2 diabetes mellitus (DM) require clear guidelines. There is no sufficient empirical evidence to support the use of one second-line agent over the other and when to initiate second-line drug is still under discrepancy. Objectives: To analyze the utilization pattern and effectiveness of second-line agents in uncomplicated type 2 DM. Methodology: 240 uncomplicated type 2 DM patients who were ≥ 18 years receiving either metformin/sulfonylurea or metformin+sulfonylurea was divided into four add-on treatment group 1, 2, 3, 4; that were added pioglitazone, dipeptidyl peptidase-4(DPP-4) inhibitor, voglibose, and insulin [pre-mixed insulin (30%regular/70%NPH)] respectively and received the second-line agents for a duration of 6 months or longer. Effectiveness was based on the reduction in glycosylated hemoglobin (HbA1C), fasting plasma glucose (FPG) and postprandial blood glucose (PPBG) values over 3 and 6 months was done using repeated measures analysis of variance (ANOVA). Results: The mean difference for reduction in HbA1C (%) values at 3rd and 6th month with respect to baseline values was 1.32±0.72 and 2.11±0.97; 1.19±0.27 and 1.81±0.53; 1.16±0.41 and 1.66±0.63; 0.97±0.16 and 1.46±0.47 for pioglitazone, DPP-4 inhibitor, voglibose, insulin respectively. The mean difference in FPG and PPBG levels at the 6th month from baseline was 75±31.06 and 115.3±40.32; 77.91±37.95 and 117±41.27; 85.87±21.75 and 118.75±55.86; 91.38±31.8 and 132.03±56.24 for pioglitazone, DPP-4 inhibitors, voglibose and insulin respectively. Reduction in HbA1C, FPG, and PPBG was statistically significant within each group at each time interval with p-value < 0.001. Conclusion: All the add-on groups exhibited a significant reduction in HbA1C, FPG, and PPBG over 3 and 6 months. DPP-4 inhibitors exhibited least hypoglycemic episodes. DPP-4 inhibitors are trending and marginally more effective second-line OHA in uncomplicated type 2 DM.

Original languageEnglish
Pages (from-to)334-339
Number of pages6
JournalJournal of Young Pharmacists
Volume10
Issue number3
DOIs
Publication statusPublished - 01-07-2018

Fingerprint

Dipeptidyl-Peptidase IV Inhibitors
pioglitazone
Tertiary Healthcare
Type 2 Diabetes Mellitus
Blood Glucose
Fasting
Glucose
Metformin
Insulin
Biphasic Insulins
Therapeutics
Glycosylated Hemoglobin A
Hypoglycemic Agents
Pharmaceutical Preparations
Analysis of Variance
Guidelines
voglibose

All Science Journal Classification (ASJC) codes

  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

@article{628a090c61574493833b247c3ee3f113,
title = "Effectiveness of second-line agents in the treatment of uncomplicated type 2 diabetes mellitus: An observational tertiary-care based study",
abstract = "Background: The rational prescribing of second-line drugs in type 2 diabetes mellitus (DM) require clear guidelines. There is no sufficient empirical evidence to support the use of one second-line agent over the other and when to initiate second-line drug is still under discrepancy. Objectives: To analyze the utilization pattern and effectiveness of second-line agents in uncomplicated type 2 DM. Methodology: 240 uncomplicated type 2 DM patients who were ≥ 18 years receiving either metformin/sulfonylurea or metformin+sulfonylurea was divided into four add-on treatment group 1, 2, 3, 4; that were added pioglitazone, dipeptidyl peptidase-4(DPP-4) inhibitor, voglibose, and insulin [pre-mixed insulin (30{\%}regular/70{\%}NPH)] respectively and received the second-line agents for a duration of 6 months or longer. Effectiveness was based on the reduction in glycosylated hemoglobin (HbA1C), fasting plasma glucose (FPG) and postprandial blood glucose (PPBG) values over 3 and 6 months was done using repeated measures analysis of variance (ANOVA). Results: The mean difference for reduction in HbA1C ({\%}) values at 3rd and 6th month with respect to baseline values was 1.32±0.72 and 2.11±0.97; 1.19±0.27 and 1.81±0.53; 1.16±0.41 and 1.66±0.63; 0.97±0.16 and 1.46±0.47 for pioglitazone, DPP-4 inhibitor, voglibose, insulin respectively. The mean difference in FPG and PPBG levels at the 6th month from baseline was 75±31.06 and 115.3±40.32; 77.91±37.95 and 117±41.27; 85.87±21.75 and 118.75±55.86; 91.38±31.8 and 132.03±56.24 for pioglitazone, DPP-4 inhibitors, voglibose and insulin respectively. Reduction in HbA1C, FPG, and PPBG was statistically significant within each group at each time interval with p-value < 0.001. Conclusion: All the add-on groups exhibited a significant reduction in HbA1C, FPG, and PPBG over 3 and 6 months. DPP-4 inhibitors exhibited least hypoglycemic episodes. DPP-4 inhibitors are trending and marginally more effective second-line OHA in uncomplicated type 2 DM.",
author = "Rupam Gill and Shalini Adiga and Muralidhar Varma",
year = "2018",
month = "7",
day = "1",
doi = "10.5530/jyp.2018.10.74",
language = "English",
volume = "10",
pages = "334--339",
journal = "Journal of Young Pharmacists",
issn = "0975-1483",
publisher = "E-Flow Medknow Publications",
number = "3",

}

TY - JOUR

T1 - Effectiveness of second-line agents in the treatment of uncomplicated type 2 diabetes mellitus

T2 - An observational tertiary-care based study

AU - Gill, Rupam

AU - Adiga, Shalini

AU - Varma, Muralidhar

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background: The rational prescribing of second-line drugs in type 2 diabetes mellitus (DM) require clear guidelines. There is no sufficient empirical evidence to support the use of one second-line agent over the other and when to initiate second-line drug is still under discrepancy. Objectives: To analyze the utilization pattern and effectiveness of second-line agents in uncomplicated type 2 DM. Methodology: 240 uncomplicated type 2 DM patients who were ≥ 18 years receiving either metformin/sulfonylurea or metformin+sulfonylurea was divided into four add-on treatment group 1, 2, 3, 4; that were added pioglitazone, dipeptidyl peptidase-4(DPP-4) inhibitor, voglibose, and insulin [pre-mixed insulin (30%regular/70%NPH)] respectively and received the second-line agents for a duration of 6 months or longer. Effectiveness was based on the reduction in glycosylated hemoglobin (HbA1C), fasting plasma glucose (FPG) and postprandial blood glucose (PPBG) values over 3 and 6 months was done using repeated measures analysis of variance (ANOVA). Results: The mean difference for reduction in HbA1C (%) values at 3rd and 6th month with respect to baseline values was 1.32±0.72 and 2.11±0.97; 1.19±0.27 and 1.81±0.53; 1.16±0.41 and 1.66±0.63; 0.97±0.16 and 1.46±0.47 for pioglitazone, DPP-4 inhibitor, voglibose, insulin respectively. The mean difference in FPG and PPBG levels at the 6th month from baseline was 75±31.06 and 115.3±40.32; 77.91±37.95 and 117±41.27; 85.87±21.75 and 118.75±55.86; 91.38±31.8 and 132.03±56.24 for pioglitazone, DPP-4 inhibitors, voglibose and insulin respectively. Reduction in HbA1C, FPG, and PPBG was statistically significant within each group at each time interval with p-value < 0.001. Conclusion: All the add-on groups exhibited a significant reduction in HbA1C, FPG, and PPBG over 3 and 6 months. DPP-4 inhibitors exhibited least hypoglycemic episodes. DPP-4 inhibitors are trending and marginally more effective second-line OHA in uncomplicated type 2 DM.

AB - Background: The rational prescribing of second-line drugs in type 2 diabetes mellitus (DM) require clear guidelines. There is no sufficient empirical evidence to support the use of one second-line agent over the other and when to initiate second-line drug is still under discrepancy. Objectives: To analyze the utilization pattern and effectiveness of second-line agents in uncomplicated type 2 DM. Methodology: 240 uncomplicated type 2 DM patients who were ≥ 18 years receiving either metformin/sulfonylurea or metformin+sulfonylurea was divided into four add-on treatment group 1, 2, 3, 4; that were added pioglitazone, dipeptidyl peptidase-4(DPP-4) inhibitor, voglibose, and insulin [pre-mixed insulin (30%regular/70%NPH)] respectively and received the second-line agents for a duration of 6 months or longer. Effectiveness was based on the reduction in glycosylated hemoglobin (HbA1C), fasting plasma glucose (FPG) and postprandial blood glucose (PPBG) values over 3 and 6 months was done using repeated measures analysis of variance (ANOVA). Results: The mean difference for reduction in HbA1C (%) values at 3rd and 6th month with respect to baseline values was 1.32±0.72 and 2.11±0.97; 1.19±0.27 and 1.81±0.53; 1.16±0.41 and 1.66±0.63; 0.97±0.16 and 1.46±0.47 for pioglitazone, DPP-4 inhibitor, voglibose, insulin respectively. The mean difference in FPG and PPBG levels at the 6th month from baseline was 75±31.06 and 115.3±40.32; 77.91±37.95 and 117±41.27; 85.87±21.75 and 118.75±55.86; 91.38±31.8 and 132.03±56.24 for pioglitazone, DPP-4 inhibitors, voglibose and insulin respectively. Reduction in HbA1C, FPG, and PPBG was statistically significant within each group at each time interval with p-value < 0.001. Conclusion: All the add-on groups exhibited a significant reduction in HbA1C, FPG, and PPBG over 3 and 6 months. DPP-4 inhibitors exhibited least hypoglycemic episodes. DPP-4 inhibitors are trending and marginally more effective second-line OHA in uncomplicated type 2 DM.

UR - http://www.scopus.com/inward/record.url?scp=85050292402&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050292402&partnerID=8YFLogxK

U2 - 10.5530/jyp.2018.10.74

DO - 10.5530/jyp.2018.10.74

M3 - Article

VL - 10

SP - 334

EP - 339

JO - Journal of Young Pharmacists

JF - Journal of Young Pharmacists

SN - 0975-1483

IS - 3

ER -