Effects on Metabolic Parameters of Addition of SGLT‐2 Inhibitors on Patients with Type2 Diabetes Inadequately Controlled with DPP‐IV Inhibitors and Metformin

Background: Practice guidelines are open regarding choice of therapy after metformin. The second line agent's insulin (INS), sulphonylureas (SU) and thiazolidinediones (TZD) may cause either hypoglycaemia or weight gain. Dipeptidyl peptidase‐IV (DPP-4) inhibitors are unlikely to produce that. Sodium‐glucose transporter‐2 (SGLT -2) inhibitors are newer agents with the advantage of weight loss. Indian data regarding combination therapy with Metformin withDPP-4 inhibitors plus SGLT-2 inhibitors arescanty; hence this study is relevant .Moreover the number of patients studied, duration of study, study variables and effects of three SGLT-2inhibitors were analyzed separately. Objectives: To study the glycaemic and other metabolic parameters after treatment with SGLT‐2 inhibitors-canagliflozin or, dapagliflozin, or, empagliflozin in type 2 Diabetes (T2DM) patient inadequately controlled (HbA1c >7.5%) with DPP-4 inhibitors plus metformin. Methodology: Data of 101 T2DM patients inadequately controlled (HbA1c> 7.5%) with DPP-4 inhibitors plus metformin who were prescribed canagliflozin 100 mg or, dapagliflozin 5 or 10 mg, or empagliflozin 10 mg or 25 mg once daily with mean follow‐up duration of 23 weeks were analyzed. Subjects receiving INS, SU and TZD were excluded from analysis. Changes in weight, blood pressure, glycaemia, lipids, renal and hepatic parameters were studied. Subgroup analyses were done to see effects of three SGLT‐2 inhibitors. Results: Results showed that addition of SGLT-2 inhibitors produced favourable effects on all metabolic parameters studied. Conclusion: Our study shows that addition of SGLT2 inhibitors on existing therapy with DPP-4 inhibitors and metformin produces favourable effects on metabolic parameters with the advantage of weight loss and without producing major hypoglycaemic events.