Wilding J, et al. - In this population-based cohort study, the researchers assessed changes in HbA1c and weight, as well as treatment persistence, correlated with different second-line therapies used in UK clinical practice. They found that all second-line therapies added to metformin monotherapy improved glycaemic control. Data reported that the lowest treatment change/discontinuation rate and most sustained weight loss was seen with subjects receiving metformin plus a sodium–glucose cotransporter-2 inhibitor (SGLT-2 inhibitor).

Methods

• For this analysis, researchers used the UK Clinical Practice Research Datalink to identify patients with type 2 diabetes (T2D) who started second-line therapy after metformin monotherapy between 1 August 2013 and 14 June 2016.
• They evaluated treatment persistence and changes in HbA1c and weight at 6-month intervals up to 18 months.

Results

• Nine thousand, ninety-seven patients (mean age 61.2 years, 57.2% men, mean [standard deviation] HbA1c 9.0% [1.8]/ 75 mmol/mol [19.7]) were incorporated in the analysis, with a median 2.3 years between starting metformin monotherapy and initiating second-line therapy.
• Researchers stratified patients according to second-line therapy: metformin in combination with sulfonylurea (SU; n = 4655 [51.2%]), a dipeptidyl peptidase-4 inhibitor (DPP-4 inhibitor; n = 2899 [31.9%]), or a sodium–glucose cotransporter-2 inhibitor (SGLT-2 inhibitor; n = 441 [4.9%]) or other therapies (all other second-line treatments; n = 1102 [12.1%]).
• It was observed that the cumulative proportion of patients changing treatment was lowest for those who received metformin plus an SGLT-2 inhibitor (42.3%), followed by patients on metformin plus SU or metformin plus a DPP-4 inhibitor (46.8%) at 18 months.
• The findings demonstrated that HbA1c reductions were seen with all second-line therapies, with an overall mean (standard error) reduction of -1.23% (0.05)/-13.4 mmol/mol (0.5).
• The outcomes revealed that changes were directly, but not linearly, related to baseline HbA1c and were greater in those with higher HbA1c at baseline.
• It was noted that weight loss from baseline was greatest in patients treated with metformin plus either an SGLT-2 inhibitor (-4.2 kg) or a DPP-4 inhibitor (-1.5 kg).
• According to the findings obtained, the highest proportion of patients who achieved the composite outcome of HbA1c reduction ≥ 0.5%, body weight loss ≥ 2.0 kg and treatment persistence for 18 months was found in those receiving metformin plus an SGLT-2 inhibitor (36.5%).