Comparative Clinical Analysis of DPP-4 inhibitors and SGLT2 Inhibitors: A Real-World Switch Study

Area of Science:

• Endocrinology
• Pharmacology
• Metabolic Diseases

Background:

• Dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose co-transporter 2 (SGLT2) inhibitors are key oral antidiabetic agents.
• Real-world comparative effectiveness data is vital for optimizing type 2 diabetes mellitus (T2DM) treatment.

Purpose of the Study:

• To compare the real-world effectiveness of switching between DPP-4 and SGLT2 inhibitors in adults with T2DM.
• To evaluate changes in glycemic control, metabolic parameters, and organ function post-switch.

Main Methods:

• Retrospective analysis of adults with T2DM switching between DPP-4 and SGLT2 inhibitors (2014-2023).
• Inclusion criteria: baseline HbA1c 6.5-10.0%, metformin use, eGFR ≥45 mL/min/1.73 m².
• 1:1 propensity-score matching for baseline HbA1c and FPG; 84 patients per group (n=168 total).

Main Results:

• Switching to DPP-4 inhibitors showed a significantly greater reduction in HbA1c (β, -0.26; P<0.001).
• Switching to SGLT2 inhibitors led to significant improvements in fasting plasma glucose (FPG) (β, 10.50; P<0.001) and liver enzymes.
• DPP-4 inhibitor benefits were more pronounced in older patients, those with lower BMI, higher baseline HbA1c, or chronic kidney disease.

Conclusions:

• DPP-4 inhibitors significantly reduce HbA1c levels.
• SGLT2 inhibitors effectively improve FPG and liver-related metabolic parameters.
• Treatment choice may be guided by patient characteristics and specific therapeutic goals.