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Endocrine Abstracts (2024) 99 EP1268 | DOI: 10.1530/endoabs.99.EP1268

1University Hospital of Gran Canaria Dr. Negrín, Endocrinology & Nutrition, Las Palmas de Gran Canaria, Spain; 2Parc Taulí University Hospital, Endocrinology & Nutrition, Sabadell, Spain; 3Clinica San Roque, Endocrinology & Nutrition, Las Palmas de Gran Canaria, Spain; 4Centro Salud Escaleritas, Family & Community Medicine, Las Palmas de Gran Canaria, Spain; 5Clínica Cajal, Family & Community Medicine, Las Palmas de Gran Canaria, Spain; 6University Hospital of Gran Canaria Dr. Negrín, Emergency Medicine, Las Palmas de Gran Canaria, Spain


Introduction and Objectives: The tolerance of extended-release metformin (XRM) is superior to that of conventional metformin. XRM is recently available in Spain as a fixed combination with sitagliptin, but not in monotherapy. There are no data yet on how additional antidiabetic treatment can modify the effects of the XRM/sitagliptin combination. After assessing the efficacy and tolerability of XRM/sitagliptin in patients with T2DM labelled as metformin-intolerant and treated with a DPP4 inhibitor (DPP4i), we performed additional analyses in order to assess if additional treatment could modify these results.

Patients and Methods: Consecutive patients with T2DM, HbA1c >7% and GFR (CKD-EPI) >45 mL/min/1.73m2 labelled as metformin-intolerant due to gastrointestinal symptoms, and treated with a DPP4i were switched to the 50 mg sitagliptin plus 1000 mg XRM combination, taking 1 pill daily in the first month and afterwards 2 pills if the tolerance was good. Tolerance data were obtained by questionnaire in the follow-up visit. All Included patients granted informed consent.

Results: 29 patients previously treated with SGLT2i (17 with empagliflozin, 8 with dapagliflozin and 4 with canagliflozin) could be pooled and analyzed vs. 43 not treated with any SGLT2i. No patient was treated with metformin (due to assumed intolerance); all were treated with DPP4i (by protocol) but none with a GLP-1ra (due to incompatibility with iDPP4); 5 patients were treated with insulin, 4 with gliclazide, 3 with repaglinide and 3 with pioglitazone; these drugs were unsuitable for analysis due to sample size. There were no significant differences for the reductions in fasting glycemia (without SGLT2i: 36±16 mg/dl with 1 pill, 45±17 mg/dl with 2 pills; with SGLT2i 32±16 mg/dl with 1 pill, 40±13 mg/dl with 2 pills) or in HbA1c (without SGLT2i: 0.64±0.30% with 1 pill, 0.95±0.32% with 2 pills; with SGLT2i 0.59±0.28% mg/dl with 1 pill, 0.91±0.30% with 2 pills) induced by the switch from DPP4i to XRM/sitagliptin in patients with vs. without previous SGLT2i treatment. There were also no significant differences for tolerance: without SGLT2i: 8 patients (18.6%) did not tolerate the rechallenge, and 5 (11.6%) tolerated only 1 pill; with SGLT2i, 4 (13.8%) did not tolerate, and 3 (10.3%) tolerated only 1 pill.

Conclusions: A large majority of the patients with T2DM labelled as metformin-intolerant and treated with DPP4i tolerated XRM/sitagliptin, and their fasting blood glucose and HbA1c significantly improved. The concomitant use of iSGLT2i did not modify these results. Other antidiabetic treatments could not be meaningfully analyzed.

Volume 99

26th European Congress of Endocrinology

Stockholm, Sweden
11 May 2024 - 14 May 2024

European Society of Endocrinology 

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