Sitagliptin Versus Ipragliflozin for Type 2 Diabetes in Clinical Practice

Background: Dipeptidyl peptidase-4 inhibitors and sodium-glucose cotransporter-2 inhibitors are frequently used to treat type 2 diabetes. However, there have been no direct comparisons of these antidiabetic drugs in Japanese patients with type 2 diabetes. Methods: We retrospectively assessed the effects of treatment with sitagliptin (a dipeptidyl peptidase-4 inhibitor) for 24 weeks in the ASSET-K study or treatment with ipragliflozin (a sodium-glucose cotransporter-2 inhibitor) for 24 weeks in the ASSIGN-K study. In both studies, patients with poor glycemic control received the study drug in addition to standard care with/without other antidiabetic medications or were switched to the study drug. The effects of each drug on metabolic risk factors (body weight, blood glucose, and lipids), blood pressure, and renal function were compared. Results: After 4 weeks of treatment, hemoglobin A1c was significantly lower in patients receiving ipragliflozin than in those receiving sitagliptin, but the difference was not significant at 12 or 24 weeks. Body mass index showed a significantly larger decrease with ipragliflozin treatment than sitagliptin treatment throughout most of the study period (P < 0.001 at 24 weeks). The mean blood pressure also showed a significantly larger decrease with ipragliflozin treatment than sitagliptin treatment throughout most of the study period (P = 0.007 at 24 weeks). In contrast, the decrease of the estimated glomerular filtration rate after 24 weeks was significantly larger in patients treated with sitagliptin than those receiving ipragliflozin (P = 0.012). Conclusions: Ipragliflozin may be more effective than sitagliptin for Japanese patients with type 2 diabetes who have hypertension, obesity, and/or renal dysfunction. J Endocrinol Metab. 2019;9(5):151-158 doi: https://doi.org/10.14740/jem604