TY - JOUR
T1 - Urinary albumin excretion with sitagliptin compared to sulfonylurea as add on to metformin in type 2 diabetes patients with albuminuria
T2 - A real-world evidence study
AU - Goldshtein, Inbal
AU - Karasik, Avraham
AU - Melzer-Cohen, Cheli
AU - Engel, Samuel S.
AU - Yu, Shengsheng
AU - Sharon, Ofer
AU - Brodovicz, Kimberly
AU - Gadir, Noga
AU - Katzeff, Harvey L.
AU - Radican, Larry
AU - Chodick, Gabriel
AU - Shalev, Varda
AU - Tunceli, Kaan
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Aim To compare the change in urinary albumin to creatinine ratio (UACR) in type 2 diabetes (T2DM) patients with albuminuria who initiate sitagliptin to those who initiate a sulfonylurea (SU) as add-on to metformin monotherapy. Method A cohort of T2DM patients with albuminuria (UACR > 30 mg/g) who initiated sitagliptin or SU as add-on dual therapy to metformin between 2008 and 2014 was extracted from the computerized medical records of a large managed care organization in Israel. Patients with albuminuria and UACR measurements available at treatment initiation and 120–365 days afterwards were included. Propensity scores were calculated based on 17 factors, including demography, comorbidities, baseline levels of HbA1c, UACR, BMI, eGFR, and ACE/ARB use, and patients were matched in a 1:1 ratio. Changes in UACR were compared between the matched pairs using generalized estimating equations. Results A total of 282 eligible pairs (sitagliptin:SU) were identified. During a mean follow-up of 9 months, median UACR changes were − 35% (IQR = − 73% to 5%) and − 31% (IQR = − 72% to 21%) in the sitagliptin and SU groups, respectively. Mean absolute HbA1c reductions among sitagliptin and SU groups were 0.9% and 1.0%, respectively. The magnitude of UACR reduction generally increased with greater magnitude of HbA1c reduction in both treatment groups. However, after controlling for HbA1c reduction and the interaction between HbA1c reduction and UACR reduction, sitagliptin users demonstrated a trend toward an increased likelihood of UACR reduction compared to SU users (odds ratio = 1.20; 95% confidence interval: 0.99–1.47, P = 0.063). Conclusion Our results suggest that both sitagliptin and SU reduce albuminuria as an add-on therapy to metformin, but that sitagliptin may provide greater reductions in albuminuria independent of glycemic control when compared to SU. Larger population studies are required to further explore this.
AB - Aim To compare the change in urinary albumin to creatinine ratio (UACR) in type 2 diabetes (T2DM) patients with albuminuria who initiate sitagliptin to those who initiate a sulfonylurea (SU) as add-on to metformin monotherapy. Method A cohort of T2DM patients with albuminuria (UACR > 30 mg/g) who initiated sitagliptin or SU as add-on dual therapy to metformin between 2008 and 2014 was extracted from the computerized medical records of a large managed care organization in Israel. Patients with albuminuria and UACR measurements available at treatment initiation and 120–365 days afterwards were included. Propensity scores were calculated based on 17 factors, including demography, comorbidities, baseline levels of HbA1c, UACR, BMI, eGFR, and ACE/ARB use, and patients were matched in a 1:1 ratio. Changes in UACR were compared between the matched pairs using generalized estimating equations. Results A total of 282 eligible pairs (sitagliptin:SU) were identified. During a mean follow-up of 9 months, median UACR changes were − 35% (IQR = − 73% to 5%) and − 31% (IQR = − 72% to 21%) in the sitagliptin and SU groups, respectively. Mean absolute HbA1c reductions among sitagliptin and SU groups were 0.9% and 1.0%, respectively. The magnitude of UACR reduction generally increased with greater magnitude of HbA1c reduction in both treatment groups. However, after controlling for HbA1c reduction and the interaction between HbA1c reduction and UACR reduction, sitagliptin users demonstrated a trend toward an increased likelihood of UACR reduction compared to SU users (odds ratio = 1.20; 95% confidence interval: 0.99–1.47, P = 0.063). Conclusion Our results suggest that both sitagliptin and SU reduce albuminuria as an add-on therapy to metformin, but that sitagliptin may provide greater reductions in albuminuria independent of glycemic control when compared to SU. Larger population studies are required to further explore this.
KW - Albuminuria
KW - DPP-4 inhibitors
KW - Nephropathy
KW - Sitagliptin
KW - Sulfonylurea
UR - http://www.scopus.com/inward/record.url?scp=84990960882&partnerID=8YFLogxK
U2 - 10.1016/j.jdiacomp.2016.05.012
DO - 10.1016/j.jdiacomp.2016.05.012
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C2 - 27320183
AN - SCOPUS:84990960882
SN - 1056-8727
VL - 30
SP - 1354
EP - 1359
JO - Journal of Diabetes and its Complications
JF - Journal of Diabetes and its Complications
IS - 7
ER -