Endocrine Abstracts

Introduction: Before launching of SGL¬T-2 inhibitor, triple combination of TZD with metformin and DPP¬4 inhibitor was best option for delaying progression of diabetes by improving insulin resistance and secretory dysfunction. SGLT-2 inhibitor can be used as first combination therapy with metformin, but add on to any diabetic combination will be favorable in terms of body weight and cardiovascular risk reduction, especially in long duration of diabetes with relatively high risk of cardiovascular complication. SGLT-2 inhibitor is better than sulfonylurea in preserving beta cell reserve and preventing diabetic complication, so we tried to know the effect of SGLT-2 inhibitor add on to triple combination because there are few studies about those combination therapy excluding sulfonylurea.

Subject and Methods: In 62 patients with relatively long duration of diabetes that did not reach the goal of HbA1c 7.0% with triple combination with metformin, DPP-4 inhibitor and TZD, SGLT-2 inhibitor-10 mg of empagliflozin or usual or half dose dapagliflozin(5mg) was added due to economical cause because add on to TZD or DPP-4 inhibitor is not covered by national insurance in this country. The clinical characteristics and changes of HbA1c by dose of SGLT-2 inhibitor, body weight were assessed.

Results: The mean age was 63.5±9.2 and duration of diabetes was 13.6±6.2 years. The fasting C-peptide was 2.26±1.09 ng/ml and BMI was 27.3±3.7. The mean of 3 months and just before add on HbA1c level was 7.89±1.00%. The HbA1c level was 7.24±0.87% and 7.14±0.71 after 6 and 12 months after add on, so it was lowered by 0.65% and 0.76% each. HbA1c lowering effect was greater in usual dose of dapagliflozin than half dose and 10 mg of empagliflozin (0.86% vs 0.49% and 0.57% at 6 months, 1.12% vs 0.41 and 0.75% at 12 months, P<0.05). Body weight was decreased by 1.89±2.82 after 6 months.

Conclusion: SGLT-2 inhibitor including half dose of empagliflozin and dapagliflozin add on to triple combination of TZD with metformin and DPP--4 inhibitor was effective in body weight as well as glucose lowering effect, so quadriple combination therapy except sulfonylurea can be effective in glucose control and preserving beta cell function before initiation of insulin treatment.