EASD 2022: Interactions between Early DPP-4is Initiation and HbA1c Variability with Risk of Insulin Requirement in Type 2 Diabetes: Real-World Evidence from a Prospective Cohort
Dipeptidyl peptidase‐4 inhibitors (DPP-4is) impart their glucose lowering action by inhibiting the degradation of glucagon‐like peptide‐1 (GLP-1) which suppresses glucagon and increases prandial insulin secretion. Clinical evidence suggests that early treatment with metformin and DPP4i combination can have reduced treatment escalation and delayed insulin requirement. The abstract presented demonstrates the interaction between early DPP4i use and HbA1c variability on the risk of insulin requirement in T2D.
The population-based prospective study included 103,744 subjects with T2D treated with DPP4is in 2007-2018 followed up till 2019 in Hong Kong. Baseline levels were considered as the 1-year period before the first date of DPP4i administration; 24,147 patients (53.3% men, age: 63.9±11.6 years, HbA1c: 8.3±1.3%, diabetes duration: 12.3±7.1 years) fulfilled inclusion criteria. Insulin requirement was defined as continuous insulin treatment for at least six months during follow-up. HbA1c variability score (HVS) was referred to as the as percentage of HbA1c values varying by 0.5% compared with the preceding value. It can be observed from the results that 20.6% patients required insulin during the follow-up period of 4.1 years. There was a lower risk of insulin requirement with early initiation of DPP4i as compared to late initiation [ hazard ratio [HR] of 0.71 (95% CI: 0.66-0.77)]. When categorized according to HVS values, the group with low HVS values had a low risk of insulin requirement as compared to the high HVS group [HR ratio 0.59 (0.56-0.63)]. Early initiation of DPP-4is and low-HVS (P interaction <0.001) were associated with the lowest risk of insulin requirement.
In conclusion, the observed results indicate that early initiation of DPP-4is as combination therapy may help delay insulin requirement especially in those with low HbA1c variability.
Abstract # 622, Session: SO 47 European Association for the Study of Diabetes (EASD) International Congress 2022, 19th – 23rd Sept. 2022, Stockholm
