Sitagliptin vs. pioglitazone as add-on treatments in patients with uncontrolled type 2 diabetes on the maximal dose of metformin plus sulfonylurea

AimsTo compare the efficacy of sitagliptin versus pioglitazone as add-on drugs in patients with poorly controlled diabetes with metformin and sulfonylureas.MethodsThis is a randomized, open-label, parallel assignment clinical trial. Patients who had inadequate glycemic control [7% (53mmol/mol)A1C<11% (97mmol/mol)] despite a minimum 6-month period of active treatment with metformin 2000mg/day plus gliclazide 240mg/day were enrolled in the study. HbA1C, fasting blood glucose (FBG), fasting plasma lipid parameters [total cholesterol (TC0, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C)], systolic and diastolic blood pressure (SBP, DBP), weight, waist circumference, and body mass index were measured at baseline and after 17, 34, and 52weeks of treatment. Generalized estimating equation analysis was done to compare treatment groups for continuous efficacy parameters.ResultsNo significant difference in HbA1C reduction was observed between the treatment groups during the study course. (P=0.149, adjusted P=0.434; coefficient -0.110.08). The FBG (P=0.032; coefficient 7.44 +/- 3.48), HDL-C (P=0.001; coefficient -2.69 +/- 0.83), TG (P=0.027; coefficient 12.63 +/- 5.71) and SBP (P<0.001; coefficient 5.43 +/- 1.26) changes from baseline, and weight gain were greater in the pioglitazone group. The mean changes in LDL-C and TC from baseline to week 52 were greater in the sitagliptin group (P=0.034; coefficient -7.40 +/- 3.50, P=0.013; coefficient -7.16 +/- 2.88, respectively).Conclusion Sitagliptin and pioglitazone were equally effective in improvement of HbA1C. There were some differences in terms of lipid indices, weight gain, and SBP. The current study confirmed that both sitagliptin and pioglitazone are effective treatment options and the decision should be made for each individual based on the baseline characteristics.