A short-term follow-up of glycemic and body weight changes in diabetic patients who replaced dipeptidyl peptidase-4 inhibitors with the sodium-glucose cotransporter 2 inhibitor empagliflozin

Abstract

BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT2is, gliflozins) are associated with lower all-cause mortality than other anti-diabetic agents in patients with type 2 diabetes. In patients who may benefit from SGLT2is, but cannot add them to a dipeptidyl peptidase-4 inhibitor (DPP4i, gliptin) treatment for various reasons, replacement of the DPP4i with a SGLT2i may be considered. OBJECTIVES: Evaluate changes in metabolic parameters in patients with diabetes after replacing a DPP4i with the SGLT2i empagliflozin. DESIGN: Panel study (cross-sectional and cohort hybrid). SETTING: The diabetes outpatient clinics of Chang Gung Memorial Hospital at Linkou, a university hospital in Taiwan. PATIENTS AND METHODS: We reviewed the medical records of patients who had been treated with anti-diabetic agents including a DPP4i between May 2016 and May 2017. Patients who switched from DPP4is to empagliflozin (switched-to-empagliflozin group) without changes to other anti-diabetic agents for at least 6 months were compared patients who continued taking an original antidiabetic agent. The body weight (BW), body mass index (BMI), and glycated hemoglobin (HbA1c) level at baseline and after 3 and 6 months were collected for analysis. MAIN OUTCOME MEASURES: BW, BMI, HbA1c at baseline, 3 and 6 months. SAMPLE SIZE: 236 patients. RESULTS: The HbA1c level and BMI of 110 patients (71%) in the switched-to-empagliflozin group were significantly reduced at 6 months after the switch, and there was a significant negative correlation between baseline HbA1c and change in HbA1c (rho=-0.537, P <.001). In another 45 patients (29%) who switched to empagliflozin, HbA1c did not have improve, but BW decreased after the switch. No significant change in HbA1c occurred in the group that remained on DPP4is. In addition, BW and BMI decreased regardless of the degree of glucose reduction in the switched-to-empagliflozin group (P<.001 for both variables at 6 months vs baseline), but not in the patients who remained on DPP4is. CONCLUSIONS: The study demonstrated the metabolic impact of switching from a DPP4i to a well-known SGLT2i, but further large-scale trials are needed to study the long-term effects of replacing a DPP4i with a SGLT2i. LIMITATIONS: Retrospective design, a short observation period, a small number of patients, no evaluations of the quality of life, side effects, or the cost, and data limited to only empagliflozin. CONFLICT OF INTEREST: None.