Glucometabolic control of once-weekly dulaglutide switched from DPP4 inhibitor versus daily empagliflozin add-on in patients with type 2 diabetes inadequately controlled with metformin, sulfonylurea, and DPP4 inhibitor: A randomised trial

Eun Young Lee; Jae-Hyoung Cho; Woo Je Lee; Nam Hoon Kim; Jae Hyeon Kim; Byung-Wan Lee

doi:10.1016/j.diabres.2023.110884

Glucometabolic control of once-weekly dulaglutide switched from DPP4 inhibitor versus daily empagliflozin add-on in patients with type 2 diabetes inadequately controlled with metformin, sulfonylurea, and DPP4 inhibitor: A randomised trial

Diabetes Res Clin Pract. 2023 Sep:203:110884. doi: 10.1016/j.diabres.2023.110884. Epub 2023 Aug 16.

Authors

Eun Young Lee¹, Jae-Hyoung Cho¹, Woo Je Lee², Nam Hoon Kim³, Jae Hyeon Kim⁴, Byung-Wan Lee⁵

Affiliations

¹ Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
² Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
³ Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
⁴ Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
⁵ Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: bwanlee@yuhs.ac.

PMID: 37595844
DOI: 10.1016/j.diabres.2023.110884

Abstract

Aims: To compare the effectiveness and safety of empagliflozin and dulaglutide in patients with type 2 diabetes (T2D) inadequately controlled by oral triple therapy.

Methods: In this 24-week, multi-center, randomized trial, patients with T2D and HbA_1c level ≥7.5% (58 mmol/mol) on metformin, sulfonylurea, and dipeptidyl peptidase 4 inhibitor (DPP4-i) were randomly assigned into two groups: daily empagliflozin add-on or once-weekly dulaglutide switched from DPP4-i. The primary endpoint was changes from baseline HbA_1c at 24 weeks.

Results: In total, 152 patients were recruited to the empagliflozin-added quadruple group (n = 76) or the switched-to-dulaglutide triple group (n = 76). At week 24, both groups showed significant reduction in HbA1c level from baseline with greater reduction with empagliflozin (the mean treatment difference: -0.27% [95% CI -0.50 to -0.04, p = 0.024]) (-2.88 mmol/mol [95% CI -5.37 to -0.39], p = 0.024). Empagliflozin significantly reduced body weight from baseline to week 24 (-1.72 kg [95% CI -1.98 to -0.59, p < 0.001]). No serious adverse events were reported with either empagliflozin or dulaglutide.

Conclusions: Empagliflozin, compared with once-weekly dulaglutide switched from DPP4-i, demonstrated greater HbA_1c reduction and weight loss in patients with T2D inadequately controlled with metformin, sulfonylurea, and DPP4-i.

Trial registration: cris.nih.go.kr (KCT0006157).

Keywords: Glucagon-like peptide-1 receptor agonist; Randomised trial; Sodium-glucose cotransporter 2 inhibitor; Type 2 diabetes.