Endocrine Abstracts

According to the seventh edition of diabetes atlas, 415 million persons all over the world are diabetics requiring more than 680 billion US $ annually for their management. Diabetes affects middle and low socio economic countries than developed countries. The ADA/EASD guidelines included drug price as one of the criteria to choose from different classes. Incretin based therapy are new classes for treatment of T2 DM with low incidence of hypoglycemia and modest weight loss, but its disadvantage is its higher cost compared to other agents.

Aim: The aim of this work is compare the efficacy of treating T2 DM patients with l metformin and DPP4-I fixed combination (full dose) versus continuing on only the half dose plus adding a half dose of an SU.

Methodology: This study included 194 T2 DM patients who achieved glycemic targets (A1c 7%) on fixed dose of DPP4-I and metformin twice daily, but for financial reasons part of them cannot afford to continue. So we had two groups, G1 who continued the same regimen, and G2 who will continue on only half of the dpp4i/metformin dose plus a small dose of an SU. Blood sugar, AIC weight will be measured at the start of the study and after 3 months. Major or minor Hypoglycemic events will be reported, also the treatment cost will be calculated for each group.

Results: Comparing the results of both groups, it was found that in G1 the mean A1c was 6.7 0.±42 vs 6.8±0.53 in G2, also there were no statistical significance between G1 AND g2 regarding mean FBS PPBS and weight G1 regimen had significantly fewer events of minor hypoglycemia (0.2 event/patient/3 month) compared to G2 (0.39 event/patient/3 month) (P:0.031), that is also one attack of sever hypoglycemia in G2. Also the cost of treatment per patient for 3 months was around 700 Egyptian pounds in G1 and only 420 pound for G2.

Conclusion: In our study patients who cannot afford for the full dose of DPP4-I can continue on the have dose plus a small dose of SU with the same efficacy but mild increase in the incidence of hypoglycemic events.