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Electronic medical records-based comparison of glycemic control efficacy between sulfonylureas and dipeptidyl peptidase-4 inhibitors added on to metformin monotherapy in patients with type 2 diabetes

Translational and Clinical Pharmacology 2020년 28권 4호 p.199 ~ 207
Lee Suh-Rin, 이승환, 장인진, 유경상, Rhee Su-Jin,
소속 상세정보
 ( Lee Suh-Rin ) - Seoul National University College of Medicine and Hospital Department of Clinical Pharmacology and Therapeutics
이승환 ( Lee Seung-Hwan ) - Seoul National University College of Medicine and Hospital Department of Clinical Pharmacology and Therapeutics
장인진 ( Jang In-Jin ) - Seoul National University College of Medicine and Hospital Department of Clinical Pharmacology and Therapeutics
유경상 ( Yu Kyung-Sang ) - Seoul National University College of Medicine and Hospital Department of Clinical Pharmacology and Therapeutics
 ( Rhee Su-Jin ) - Seoul National University College of Medicine and Hospital Department of Clinical Pharmacology and Therapeutics

Abstract


Sulfonylurea (SU) and dipeptidyl peptidase-4 (DPP-4) inhibitors are most common secondary agents that are added to metformin monotherapy. Real-world studies have become increasingly important in providing evidence of treatment effectiveness in clinical practice and real-world data could help appropriate therapeutic information. Therefore, this study aims to compare the glycemic effectiveness of SU and DPP-4 inhibitors, which are added to metformin monotherapy in real clinical practice using electronic medical record (EMR) data. EMR data of type 2 diabetes patients treated at Seoul National University Hospital from December 2002 to December 2012 were retrieved and analyzed. The patients were divided into three groups: patients who maintained metformin monotherapy (M), and patients who added SU (MS) or DPP-4 inhibitors (MD) to metformin monotherapy. The mean change in HbA1c level, the proportion of patients achieving the HbA1c target < 7.0%, proportion of patients with treatment failure, and probability of treatment failure occurrence and changes in prescription were evaluated to compare glycemic control efficacy between SU and DPP-4 inhibitors. The MS showed significantly greater reduction in the Hb1Ac level than MD. The proportion of patients achieving HbA1c < 7.0% is higher in MD, whereas the proportion of patients with treatment failure was greater in MS. The probability of the treatment failure and probability of changes in the prescription were lower in MD than MS with hazard ratio of 0.499 and 0.579, respectively. In conclusion, this real-world study suggested that DPP-4 inhibitors are expected to show more durable glycemic control efficacy than SU in long-term use.

키워드

Real-World Data; Type 2 Diabetes; Sulfonylureas; DPP-4 Inhibitors; Glycemic Control

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