Adding Sitagliptin to Usual Care Delays Progression to Insulin Initiation in Patients With Type 2 Diabetes: Presented at EASD

By Chris Berrie

LISBON, Portugal -- September 13, 2017 -- Adding sitagliptin to usual care among patients with type 2 diabetes well controlled on metformin or sulfonylurea therapy significantly delays progression to insulin initiation, according to a study presented here at the 2017 Annual Meeting of the European Association for the Study of Diabetes (EASD).

“There are limited data regarding the impact of sitagliptin on delaying progression to the need for insulin initiation,” said Samuel Engel, MD, Merck & Co., Inc., Rahway, New Jersey.

The Trial Evaluating Cardiovascular Outcomes With Sitagliptin (TECOS) included 14,671 patients with type 2 diabetes (haemoglobin A1C, 6.5%-8.0%) and known cardiovascular disease.

Of the patients, 11,263 were not using insulin upon study entry. In these patients, the addition of sitagliptin significantly reduced the rate of initiation of long-term insulin therapy, compared with placebo (hazard ratio[HR] = 0.70; P < .001).

The present analysis focused on patients who were on metformin (n = 4,435), sulfonylurea (n = 1,246), or dual therapy (n = 5,152).

At a median follow-up of 3.1 years, insulin was initiated in 4.7% of patients on metformin monotherapy, 11.0% of patients on sulfonylurea monotherapy, and 17.2% of patients on dual therapy.

After the addition of sitagliptin, 3.8% of patients on metformin initiated insulin compared with 5.5% with the addition of placebo. Among patients on sulfonylurea, 10.7% initiated insulin with the addition of sitagliptin compared with 11.3% of those who received placebo. The rates among those on dual therapy were 14.0% and 20.4%, respectively.

“Randomisation to sitagliptin compared with placebo was associated with delayed progression to insulin initiation among patients taking metformin monotherapy and in those patients taking metformin plus sulfonylurea therapy,” the authors concluded.

Funding for this study was provided by Merck and Co.. Inc.

[Presentation title: Time to Insulin in the Trial Evaluating Cardiovascular Outcomes With Sitagliptin. Abstract 1]

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