Key result
Administering omarigliptin as add-on therapy significantly decreased HbA1c by 0.32%, while switching from vildagliptin significantly worsened HbA1c by 0.45%.
Why the study?
Despite frequent switching from daily DPP-4 inhibitors to once-weekly omarigliptin in clinical practice, data regarding its efficacy after switching in patients with type 2 diabetes were limited.
Does omarigliptin improve glycemic control in patients with type 2 diabetes when used as an add-on or switched from daily DPP-4 inhibitors?
Cohort (n=49)
No
Does omarigliptin improve glycemic control in patients with type 2 diabetes when used as an add-on or switched from daily DPP-4 inhibitors?
Switching from vildagliptin to omarigliptin may worsen glycemic control, whereas adding omarigliptin or switching from sitagliptin or linagliptin improves or maintains it in patients with type 2 diabetes.
Answers are grounded in this paper and cite their sources.
May support switching to omarigliptin in select T2D patients; leaves open need for randomized confirmation.
BACKGROUND: Omarigliptin is one of several once-weekly dipeptidyl peptidase-4 inhibitors (DPP-4is). Despite the high frequency of switching from various daily DPP-4is to omarigliptin in actual clinical practice, data regarding its efficacy in patients with type 2 diabetes (T2D) after switching are limited. AIM: To analyze the efficacy of omarigliptin in Japanese patients with T2D who had previously received treatment with other glucose-lowering agents. METHODS: Forty-nine T2D patients treated for the first time with omarigliptin were recruited retrospectively and divided into four groups defined as either add-on or switched from daily DPP-4is: switched from linagliptin, switched from sitagliptin, and switched from vildagliptin. During a 3-mo follow-up, the clinical parameters among these groups were assessed and compared, with the impact of the switch on glycemic variability as measured by continuous glucose monitoring also being evaluated in the switched groups. The mean and standard deviation of sensor glucose value, the mean amplitude of glycemic excursions, and the mean of daily difference significantly improved when switching the patient from either linagliptin or sitagliptin to omarigliptin. However, in patients switched from vildagliptin, not only did the glucose variability indices see no improvements, the mean of daily difference even underwent significant worsening. CONCLUSION: Administering omarigliptin as add-on therapy or switching to it from sitagliptin and linagliptin, but not vildagliptin, improves glycemic control and thus should help in decision making when selecting DPP-4is for T2D patients.
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Kawasaki et al. (2021) conducted a cohort in Type 2 diabetes (n=49). Omarigliptin vs. Baseline (pre-switch daily DPP-4 inhibitors or other glucose-lowering agents) was evaluated on Change in HbA1c from baseline at 3 months (add-on group) (MD -0.32%, p=0.002). Administering omarigliptin as add-on therapy significantly decreased HbA1c by 0.32%, while switching from vildagliptin significantly worsened HbA1c by 0.45%.
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