Impact of endogenous insulin secretion on the improvement of glucose variability in Japanese patients with type 2 diabetes treated with canagliflozin plus teneligliptin

Aims/Introduction To identify the effect of combination therapy with a dipeptidyl peptidase-4 inhibitor and a sodium-glucose cotransporter 2 inhibitor compared with switching from a dipeptidyl peptidase-4 inhibitor to a sodium-glucose cotransporter 2 inhibitor on improving the glucose variability in patients with or without impaired endogenous insulin secretion. Materials and Methods A secondary analysis regarding the relationship between endogenous insulin secretion and the change in mean amplitude of glycemic excursions (Delta MAGE) was carried out in a multicenter, prospective, randomized, parallel-group comparison trial that enrolled patients with type 2 diabetes who had been taking teneligliptin and were treated by switching to canagliflozin (SWITCH) or adding canagliflozin (COMB). Participants were categorized into the following four subgroups: SWITCH or COMB and high or low fasting C-peptide (CPR) divided at baseline by the median. Results Delta MAGE in the COMB group was greatly improved independent of a high or low CPR (-29.2 +/- 28.3 vs -20.0 +/- 24.6, respectively; P = 0.60). However, Delta MAGE was not ameliorated in the low CPR SWITCH group, and the Delta MAGE was significantly smaller than that in the high CPR COMB group (P < 0.01). Conclusions COMB would be a better protocol rather than switching teneligliptin to canagliflozin to improve daily glucose variability in patients with impaired endogenous insulin secretion.

Automated summary

The study found that compared to switching from a dipeptidyl peptidase-4 inhibitor to a sodium-glucose cotransporter 2 inhibitor, combination therapy with both types of inhibitors may be a better option for improving daily glucose variability in patients with impaired endogenous insulin secretion.