COMPARATIVE EVALUATION OF THE EFFICACY AND SAFETY OF METFORMIN AND DPP-4 INHIBITORS IN TYPE 2 DIABETES MELLITUS: A PROSPECTIVE OBSERVATIONAL STUDY
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Keywords
Metformin, DPP-4 inhibitors,DPP-4 inhibitors,, Type 2 Diabetes Mellitus, efficacy, safety, glycaemic control
Abstract
Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder requiring long-term glycaemic control. Metformin is the most commonly prescribed first-line agent, while DPP-4 inhibitors are newer agents with better tolerability but higher cost. Comparative real-world data on their efficacy and safety in the Indian population remain limited.
Objective: To compare the efficacy and safety of metformin and DPP-4 inhibitors in patients with T2DM.
Methods: A prospective observational study was conducted in the Medicine and Pharmacology Departments of a tertiary care hospital over six months. A total of 120 patients with T2DM were enrolled — 60 received metformin monotherapy and 60 received DPP-4 inhibitors (sitagliptin, teneligliptin). Efficacy was assessed using fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and HbA1c at baseline, 3 months, and 6 months. Adverse effects were recorded through a standardized checklist. Data were analysed using paired and unpaired t-tests.
Results:
Baseline HbA1c levels were comparable (Metformin: 8.4 ± 1.1%, DPP-4 inhibitor: 8.3 ± 1.0%; p = 0.68). At 6 months, HbA1c reduction was significant in both groups (Metformin: 7.0 ± 0.8%, DPP-4 inhibitor: 7.1 ± 0.7%; p = 0.42).
FPG and PPG reductions were similar between groups (p > 0.05).
Common adverse effects were gastrointestinal upset (18%) with metformin and nasopharyngitis (10%) with DPP-4 inhibitors.
Dropout rates were 6.6% (metformin) and 5% (DPP-4 inhibitors).
Conclusion: Both metformin and DPP-4 inhibitors are effective in glycaemic control. Metformin remains the first-line agent due to cost-effectiveness, while DPP-4 inhibitors provide comparable efficacy with superior gastrointestinal tolerability.
References
2. American Diabetes Association. Standards of Medical Care in Diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S1–S180.
3. Bailey CJ, Turner RC. Metformin. N Engl J Med. 1996;334(9):574–579.
4. Scheen AJ. DPP-4 inhibitors in the management of type 2 diabetes: a critical review. Clin Pharmacol Ther. 2015;98(2):123–139.
5. Deacon CF. Dipeptidyl peptidase 4 inhibitors in the treatment of type 2 diabetes: a comparative review. Diabetes Obes Metab. 2011;13(1):7–18.
6. Joshi SR et al. Management of type 2 diabetes in India: practical guidelines. J Assoc Physicians India. 2020;68(5):16–24.
7. Altman DG. Practical Statistics for Medical Research. London: Chapman & Hall; 1991.
8. Bosi E et al. Effects of sitagliptin vs metformin in treatment-naïve T2DM. Diabetes Obes Metab. 2009;11(6):623–633.
9. Seino Y, et al. Efficacy and safety of teneligliptin: pooled analysis. J Diabetes Investig. 2016;7(5):587–594.
10. Matthews DR, et al. Comparative effectiveness of DPP-4 inhibitors and metformin. Diabetologia. 2017;60(9):1693–1702.
11. Gallwitz B. Clinical use of DPP-4 inhibitors. Front Endocrinol. 2019;10:389.
12. UKPDS Group. Intensive blood-glucose control with metformin. Lancet. 1998;352(9131):854–865.
13. Davies MJ, et al. Management of hyperglycemia in T2DM: 2022 consensus. Diabetes Care. 2022;45(11):2753–2786.
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Dr Syed Sujat pasha
Assistant professor, Department of Pharmacology, Alameen medical college, vijayapur, Karnataka, India
Dr Sha Naseeruddin Makandar
Assistant professor, Department of Pharmacology, Kanachur institute of medical sciences Natekal, Mangalore, Karnataka, India
Dr Lakshmipathi B S
Associate Professor, Department of Pharmacology, Koppal Institute of Medical Sciences, Koppal. Karnataka, India