Evaluation of glycemic control by metformin + glitazone + DPP-4 inhibitor + SGLT-2 inhibitor combination in patients with type 2 diabetes quitting basal/bolus insulin therapy

Abstract

Type 2 diabetes mellitus is one of the most common chronic diseases worldwide and one of the highest morbidity factors. Lowering the levels of Hemoglobin A1c (HbA1c) by strict glycemic control is the most important predictor of preventing complications. Insulin, one of the long-term drugs used to achieve this goal, however adherence and persistence to insulin therapy is not so high due to some barrier such fear of injections, fear of hypoglycaemia, obesity risk etc. This study designed to retrospectively evaluate change in glycemic control of patients with type 2 diabetes who had been on insulin therapy and wanted to quit or unwilling to use insulin therapy for any reason, and given oral antidiabetic combination therapy (metformin + glitazone + DPP-4 inhibitor + SGLT-2 inhibitor). A total of 76 patients met the inclusion criteria’s were retrospectively analyzed from hospital records. HbA1c, body mass index, and fasting plasma glucose levels were evaluated while using basal/bolus insulin therapy and after oral anti diabetic combination therapy. After antidiabetic combination therapy all glycemic control parameters significantly improved. 39.5% of the patients reached the glycemic target (HbA1c< 7%), and mean HbA1c level decreased 1.9%. The study suggested that metformin + glitazone + DPP-4 inhibitor + SGLT-2 inhibitor combination may be effective to maintain glycemic control in some type 2 diabetic patients who could not keep up insulin therapy and/or who developed clinical inertia.