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Making Choices: DPP-4i, SGLT-2i or Both in Taking Next Step After Metformin

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Dr JJ Mukherjee, Kolkata    21 November 2018

  1. Combination of DPP-4i and SGLT-2i results in greater improvement in glycemic control than each individual component alone.
  2. SGLT-2i/DPP-4i vs. DPP-4i alone yields greater reductions in HbA1c and FPG.
  3. SGLT-2i/DPP-4i vs. SGLT-2i alone - additional reductions in HbA1c and FPG are less marked.
  4. HbA1c reduction due to SGLT-2i/DPP-4i combination vs. DPP-4i alone seems to be directly proportional to baseline HbA1c.
  5. In contrast, additional HbA1c reduction due to SGLT-2i/DPP-4i combination vs. SGLT-2i alone seems modest regardless of baseline HbA1c.
  6. While the combination of SGLT-2i and DPP-4i results in a clinically meaningful reduction in HbA1c and FPG with low risk of hypoglycemia, the additional glucose control is significant when SGLT-2i is combined with or added to DPP-4i, but not the other way round.
  7. Action of SGLT-2i is unlikely to be affected by combined use with DPP-4i.

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