Subject    :    [2019 Apr;43(2)] Predictors of the Therapeutic Efficacy and Consideration of the Best Combination Therapy of Sodium-Glucose Co-transporter 2 Inhibitors
Writer KDA
Date 2019-04-18 10:29:51 Hit 453
LINK URL https://e-dmj.org/search.php?where=aview&id=10.4093/dmj.2018.0057&code=2004DMJ&vmode=FULL (Click 7)
Diabetes Metab J. 2019 Apr;43(2):158-173. English.
Published online Jan 25, 2019.  https://doi.org/10.4093/dmj.2018.0057 
Copyright © 2019 Korean Diabetes Association
   
Predictors of the Therapeutic Efficacy and Consideration of the Best Combination Therapy of Sodium-Glucose Co-transporter 2 Inhibitors
Ji-Yeon Lee,1 Yongin Cho,1 Minyoung Lee,1 You Jin Kim,1,2 Yong-ho Lee,1,3 Byung-Wan Lee,1,3 Bong-Soo Cha,1,3 and Eun Seok Kang1,3
1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
2Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
3Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Eun Seok Kang. Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Email: edgo@yuhs.ac 
 
Received April 05, 2018; Accepted October 04, 2018.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

 
Abstract

Background

We investigated the predictive markers for the therapeutic efficacy and the best combination of sodium-glucose co-transporter 2 (SGLT2) inhibitors (empagliflozin, dapagliflozin, and ipragliflozin) therapy in patients with type 2 diabetes mellitus (T2DM).

Methods

A total of 804 patients with T2DM who had taken SGLT2 inhibitor as monotherapy or an add-on therapy were analyzed. Multivariate regression analyses were performed to identify the predictors of SGLT2 inhibitor response including the classes of baseline anti-diabetic medications.

Results

After adjusting for age, sex, baseline body mass index (BMI), diabetes duration, duration of SGLT2 inhibitor use, initial glycosylated hemoglobin (HbA1c) level, estimated glomerular filtration rate (eGFR), and other anti-diabetic agent usage, multivariate analysis revealed that shorter diabetes duration, higher initial HbA1c and eGFR were associated with better glycemic response. However, baseline BMI was inversely correlated with glycemic status; lean subjects with well-controlled diabetes and obese subjects with inadequately controlled diabetes received more benefit from SGLT2 inhibitor treatment. In addition, dipeptidyl peptidase 4 (DPP4) inhibitor use was related to a greater reduction in HbA1c in patients with higher baseline HbA1c ≥7%. Sulfonylurea users experienced a larger change from baseline HbA1c but the significance was lost after adjustment for covariates and metformin and thiazolidinedione use did not affect the glycemic outcome.

Conclusion

A better response to SGLT2 inhibitors is expected in Korean T2DM patients who have higher baseline HbA1c and eGFR with a shorter diabetes duration. Moreover, the add-on of an SGLT2 inhibitor to a DPP4 inhibitor is likely to show the greatest glycemic response.

   
Keywords:
Blood glucoseDiabetes mellitus, type 2Glycated hemoglobin ASodium-glucose transporter 2 inhibitors

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