Predictors of the Efficacy of Dipeptidyl Peptidase-4 Inhibitors in Taiwanese Patients with Type 2 Diabetes Mellitus

Abstract

Background/purpose

Dipeptidyl peptidase-4 (DPP-4) inhibitors are the most popular oral antidiabetic drugs (OADs) in recent 20 years because of the low risk of hypoglycemia, intermediate efficacy to lower glycated hemoglobin (△HbA1c): 0.5–0.9%, neutral effect on body weight change, convenience for usage (mostly once daily), and rare occurrence of major side effects. The purpose of this study was to determine the important predictors of the efficacy of naïve use of DPP-4 inhibitors in Taiwanese patients with type 2 diabetes mellitus (T2D).

Methods

A retrospective observational study was conducted. Of the T2D patients, 193 (122 men) naïve DPP-4 inhibitor users with an age of 58.0 ± 12.6 years, disease duration 5.4 ± 4.7 years, body mass index (BMI) 26.1 ± 4.3 kg/m², and estimated glomerular filtration rate 95.9 ± 27.0 mL/min/1.73M² were assessed for △HbA1c in 6 months.

Results

After 6 months of DPP-4 inhibitors use, mostly second or third line of OADs (2.8 ± 0.7 kinds of OADs), 193 T2D patients (mean baseline HbA1c: 8.4 ± 1.4%) had △HbA1c 1.1 ± 1.2% on average (P < 0.01). The group with a higher baseline HbA1c level had more effective efficacy (△HbA1c ≥0.5%) in lowering HbA1c. Single regression analysis showed that the change in HbA1c after 6 months of treatment was positively associated with the baseline HbA1c level (R = 0.71, P < 0.001). In addition, multiple regression analysis showed that contributors to decrease HbA1c level after 6 months were high baseline HbA1c level, low BMI, short T2D duration, and fewer kinds of OADs.

Conclusion

Our study suggested that high baseline HbA1c level, low BMI, short T2D duration, and fewer kinds of OADs are the predictors of the efficacy of DPP-4 inhibitors in Taiwanese patients with T2D. The baseline HbA1c level, in particular, played the most important role in effective efficacy (△HbA1c ≥0.5%).

Keywords:

• dipeptidyl peptidase-4 inhibitor
• type 2 diabetes
• HbA1c
• predictor of efficacy

Acknowledgments

The authors would like to thank all the people with T2DM who participated in this study, Department of Education and Research, Taiwan Adventist Hospital for support during data collection and Enago for revision of the English. The authors were also grateful to Prof. WS Yang (National Taiwan University Hospital) for his teaching and suggestion during this study.

Ethics Approval

The Taiwan Adventist Hospital Ethics Committee approved this study. The study was conducted in accordance with the Declaration of Helsinki. Although the institutional review board specifically waived the need for patient consent due to the retrospective nature of the review, we confirmed that the data were anonymized and maintained with confidentiality during the study.

Author Contributions

Both Yi-Hsin Lin and Hsuan Huang had substantial contributions to

1. Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data;

2. Drafting the article or revising it critically for important intellectual content;

3. Final approval of the version to be published; and

4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure

The authors declare that there are no conflicts of interest.

Additional information

Funding

The work was supported by Department of Education and Research, Taiwan Adventist Hospital