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[Combination therapy of metformin vs dipeptidulpeptidase inhibitors and sulfonylureas in type 2 diabetes: clinical and economic impact].
Rev Peru Med Exp Salud Publica. 2014 Oct-Dec; 31(4):626-34.RP

Abstract

OBJECTIVES

Determine the clinical repurcussions of adherence, metabolic control, hypoglycemia and cardiovascular events (CVE) and economics (resources and costs) in the combination therapy of metformin vs DPP-4 (dipeptidyl peptidase-4) inhibitors and sulfonylureas in patients with type 2 diabetes. Materials and methods. Observational-multicenter and retrospective design. We evaluated patients ≥ 30 years of age in treatment with metformin and who started a second oral antidiabetic treatment during 2008-2009. 2 study groups were established: a) metformin + DPP-4 inhibitors, and b) metformin + sulfonylurea.

MAIN MEASURES

comorbidity, metabolic control (HbA1c <7%), compliance and complications (hypoglycemia, CVE). Follow up was conducted over two years. The cost model differentiated between direct healthcare costs (primary/ specialty care), and indirect costs (labor productivity).

STATISTICAL ANALYSIS

logistic regression and ANCOVA models. Results. 1,405 patients were recruited (average age 67.1 years old; 56.2% male). 37.0% started a second treatment with DPP-4 inhibitors, and 63.0% with sulfonylureas. After two years of follow up, patients treated with DPP-4 inhibitors showed greater treatment adherence (70.3% vs. 60.6%; p <0.001); better metabolic control (64.3% vs. 60.6%; p<0.001), and a lower proportion of hypoglycemia (13.9% vs. 40.4%; p <0.001, respectively). The average/unit of adjusted total costs was € 2,341 vs. € 2,512; p = 0.038. CVE and renal failure rates were 3.7% vs. 6.4%; p = 0.027. Vildagliptin was the most used drug among DPP-4 inhibitors. Conclusions. Sulfonylureas were the most used drug for diabetes treatment. Patients treated with DPP-4 inhibitors had higher adherence and control of diabetes, with lower rates of hypoglycemia and CVE, resulting in lower healthcare costs.

Authors+Show Affiliations

Dirección de planificación, Badalona Serveis Assistencials SA, Barcelona, España.Hospital Germans Trias i Pujol, Barcelona, España.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Observational Study

Language

spa

PubMed ID

25597711

Citation

Sicras-Mainar, Antoni, and Ruth Navarro-Artieda. "[Combination Therapy of Metformin Vs Dipeptidulpeptidase Inhibitors and Sulfonylureas in Type 2 Diabetes: Clinical and Economic Impact]." Revista Peruana De Medicina Experimental Y Salud Publica, vol. 31, no. 4, 2014, pp. 626-34.
Sicras-Mainar A, Navarro-Artieda R. [Combination therapy of metformin vs dipeptidulpeptidase inhibitors and sulfonylureas in type 2 diabetes: clinical and economic impact]. Rev Peru Med Exp Salud Publica. 2014;31(4):626-34.
Sicras-Mainar, A., & Navarro-Artieda, R. (2014). [Combination therapy of metformin vs dipeptidulpeptidase inhibitors and sulfonylureas in type 2 diabetes: clinical and economic impact]. Revista Peruana De Medicina Experimental Y Salud Publica, 31(4), 626-34.
Sicras-Mainar A, Navarro-Artieda R. [Combination Therapy of Metformin Vs Dipeptidulpeptidase Inhibitors and Sulfonylureas in Type 2 Diabetes: Clinical and Economic Impact]. Rev Peru Med Exp Salud Publica. 2014 Oct-Dec;31(4):626-34. PubMed PMID: 25597711.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Combination therapy of metformin vs dipeptidulpeptidase inhibitors and sulfonylureas in type 2 diabetes: clinical and economic impact]. AU - Sicras-Mainar,Antoni, AU - Navarro-Artieda,Ruth, PY - 2014/07/07/received PY - 2014/11/19/accepted PY - 2015/1/20/entrez PY - 2015/1/20/pubmed PY - 2017/1/5/medline SP - 626 EP - 34 JF - Revista peruana de medicina experimental y salud publica JO - Rev Peru Med Exp Salud Publica VL - 31 IS - 4 N2 - OBJECTIVES: Determine the clinical repurcussions of adherence, metabolic control, hypoglycemia and cardiovascular events (CVE) and economics (resources and costs) in the combination therapy of metformin vs DPP-4 (dipeptidyl peptidase-4) inhibitors and sulfonylureas in patients with type 2 diabetes. Materials and methods. Observational-multicenter and retrospective design. We evaluated patients ≥ 30 years of age in treatment with metformin and who started a second oral antidiabetic treatment during 2008-2009. 2 study groups were established: a) metformin + DPP-4 inhibitors, and b) metformin + sulfonylurea. MAIN MEASURES: comorbidity, metabolic control (HbA1c <7%), compliance and complications (hypoglycemia, CVE). Follow up was conducted over two years. The cost model differentiated between direct healthcare costs (primary/ specialty care), and indirect costs (labor productivity). STATISTICAL ANALYSIS: logistic regression and ANCOVA models. Results. 1,405 patients were recruited (average age 67.1 years old; 56.2% male). 37.0% started a second treatment with DPP-4 inhibitors, and 63.0% with sulfonylureas. After two years of follow up, patients treated with DPP-4 inhibitors showed greater treatment adherence (70.3% vs. 60.6%; p <0.001); better metabolic control (64.3% vs. 60.6%; p<0.001), and a lower proportion of hypoglycemia (13.9% vs. 40.4%; p <0.001, respectively). The average/unit of adjusted total costs was € 2,341 vs. € 2,512; p = 0.038. CVE and renal failure rates were 3.7% vs. 6.4%; p = 0.027. Vildagliptin was the most used drug among DPP-4 inhibitors. Conclusions. Sulfonylureas were the most used drug for diabetes treatment. Patients treated with DPP-4 inhibitors had higher adherence and control of diabetes, with lower rates of hypoglycemia and CVE, resulting in lower healthcare costs. SN - 1726-4642 UR - https://www.unboundmedicine.com/medline/citation/25597711/[Combination_therapy_of_metformin_vs_dipeptidulpeptidase_inhibitors_and_sulfonylureas_in_type_2_diabetes:_clinical_and_economic_impact]_ L2 - https://www.scielosp.org/scielo.php?script=sci_arttext&amp;pid=S1726-46342014000400003&amp;lng=en&amp;nrm=iso&amp;tlng=en DB - PRIME DP - Unbound Medicine ER -