CLINICAL RESULTS OF LONG-TERM LOBEGLITAZONE ADD-ON THERAPY IN TYPE 2 DIABETES

Abstract

INTRODUCTION
Considering the pathophysiology of type 2 diabetes, a metformin and DPP-4 inhibitor combination is the usual initial treatment option to relieve insulin resistance and improve insulin secretory dysfunction. Adding thiazolidinedione (TZD) was the next best step for delaying the progression of diabetes by preserving pancreatic beta cell function compared to sulfonylurea before launching of SGLT2 inhibitor. Lobeglitazone is another TZD launched in this country in 2016. This study wanted to determine the long-term effects of lobeglitazone when added to metformin and DPP-4 inhibitor combination therapy.

METHODOLOGY
We enrolled 196 patients who failed to reach the HbA1c target below 7% with metformin and DPP-4 inhibitor and were given add-on lobeglitazone. We checked the change in HbA1c and insulin resistance index between the groups on lobeglitazone segregated into those who discontinued the medication (stop group), who were lost to follow-up (lost group), and those who continuously took the medication (maintain group). Other clinical characteristics were also compared between groups.

RESULTS
The mean age and duration of diabetes was 61.4 and 10.1 years, respectively. The mean BMI was 26.6. The fasting c-peptide level was 2.62ng/mL and HOMA-IR was 3.87. The mean HbA1c level before add-on therapy was 7.82 ± 0.67. Lobeglitazone was discontinued in 56 patients after a mean of 3.5 years due to poor glucose control, while 51 patients were lost to follow-up. Ninety patients continued the medication for up to 5 years. HbA1c level after six months of add-on Lobeglitazone improved by 0.78 ± 0.99, 0.99 ± 0.98, and 0.92 ± 0.63 in each group. Initial HbA1c improvement was lower in those who stopped taking it. Diabetes duration was not different among the groups, but fasting C-peptide level and improvement of HOMA-IR were higher in those who maintained Lobeglitazone.

CONCLUSION
Lobeglitazone as an add-on to metformin and DPP-4 inhibitor combination was effective. The fasting C-peptide level and improvement of HOMA-IR were higher in the maintain group.