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Efficacy of gliptins and SGLT2 inhibitors compared to sulphonylureas in adult diabetics with low C-peptide levels and/or anti-GAD65 antibody positivity


Journal of Diabetes, Metabolic Disorders & Control
Ravi Kant,1 Anissa Atif Mirza,2 Aditya Sudan3

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Abstract

Introduction: LADA is an often under-recognized clinical entity that is significantly different from type 2 Diabetes Mellitus in terms of clinical phenotype and underlying patho-physiology. Present treatment protocols for diabetes don’t reflect these differences.Therapies such as DPP-4 Inhibitors have demonstrated an ability to delay decline in beta cell reserve in LADA. We studied patients with low C-peptide levels, in order to compare DPP-4 inhibitors to other first line Diabetes pharmacotherapeutic options and to assess the relationship between C-peptide levels and Anti- AD65 antibody levels.
 
Methods: The study was a Non-Randomized Controlled Trial, conducted in 156 patients with low C-peptide levels (<0.8ng/mL) who were older than 25 years of age and were recently diagnosed diabetics with a baseline HBA1c value>=6.5%. Patients included were decided into three treatment arms: Group A received Sulphonylureas + Metformin, Group B received DPP-4 inhibitors + Metformin and Group C received SGLT-2 Inhibitors + Metformin. Patient’s serum levels of Anti-GAD-65 antibodies were assessed using a sandwich ELISA kit. The three treatment groups were then compared in terms of baseline descriptive parameters and their baseline HbA1c values vis-á-vis HbA1c post 3 months of dual pharmacotherapy.
 
Results: The three treatment arms were comparable in terms of baseline parameters. 52% of the patients with low C-peptide levels had high Anti-GAD65 Antibody titers. The three treatment groups differed significantly in terms of HBA1c after 3 months of treatmentDPP-4 Inhibitors reduced HBA1c by 1.1+/-0.3%, as compared to HBA1c reduction achieved with SGLT2-inhibitors (0.8+/-0.13%) and Sulphonylureas ( 0.7+/-0.3%).
 
Conclusion: DPP-4 Inhibitors appear to provide better glycemic control, compared with alternate pharmacotherapeutic options presently available, in patients with low serum C-peptide levels.

Keywords

SGLT2 inhibitors, sulphonylureas, C-peptide levels, anti-GAD65, LADA, DPP-4, metformin, HbA1c, anti-islet

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