Category: Federal Forum Posters
Purpose: To assess glycemic control in patients with type 2 diabetes mellitus and moderate renal impairment (estimated glomerular filtration rate of 30 to 45 mL/minute/1.73m^2) receiving dose-reduced metformin, sitagliptin, or saxagliptin as monotherapy or dual therapy with a sulfonylurea or thiazolidinedione who present to the VA North Texas Health Care System.
Methods: This retrospective cohort review collected data from the VA North Texas Health Care System electronic records. We screened 1,982 subjects with type 2 diabetes and moderate renal impairment receiving dose-reduced metformin, sitagliptin, or saxagliptin as monotherapy or dual therapy with a sulfonylurea or thiazolidinedione. We compared the change in hemoglobin A1c and fasting plasma glucose (FPG) at initiation and discontinuation/ study exit of dose-reduced antihyperglycemic agents via Mann Whitney Test. We assessed the prevalence of adverse events related to metformin and dipeptidyl peptidase-4 inhibitors via descriptive analysis.
Results: A total of 26 patients were included in this analysis, of which all participants were male. The mean daily dose for metformin (N=8), saxagliptin (N=15), and sitagliptin (N=3) was 1000mg, 2.5mg, and 42mg, respectively. The average change in A1c and FPG was 0.5% and 2mg/dL for metformin, 0.1% and -7mg/dL for saxagliptin, and -0.1% and -11mg/dL for sitagliptin. There was no statistically significant difference in A1c nor FPG when comparing metformin with saxagliptin (A1c, p=0.63; FPG, p=0.54) and sitagliptin (A1c, p=0.92; FPG, p=0.92). There was one report of an adverse event related to treatment, where the subject reported arthralgia following sitagliptin initiation.
Conclusion: In this analysis of subjects with type 2 diabetes and moderate renal impairment, treatment with renal-adjusted metformin did not appear to have a difference in glycemic control as compared to renal-adjusted sitagliptin or saxagliptin.
Wei Yuet– PGY2 Ambulatory Care Pharmacy Resident, VA North Texas Health Care System, Irving, TX