1149-P: A1C Goal Attainment after Metformin (MET) Uptitration With and Without Sitagliptin (SITA): Impact of Baseline and Target A1C

MET is generally recommended as the initial AHA for T2D, but many patients do not achieve glycemic goal at an initial, sub-maximal dose (500-1000 mg/day) and should intensify therapy. Typically, MET dose is first maximized, followed by addition of a second AHA as needed. This sequential approach can result in prolonged exposure to hyperglycemia. Therefore, addition of a second AHA during MET up-titration may be appropriate for some patients. In a recent study, patients with T2D not at glycemic goal on 1000 mg/day MET initiated SITA or PBO while increasing MET dose to 2000 mg/day. Study participants had entry A1C ≥7.5% (mean = 8.6%) and baseline characteristics were balanced. SITA provided greater improvement in glycemic control and likelihood of A1C goal attainment, with similar safety and tolerability compared to PBO. In a post hoc analysis characterizing the impact of baseline A1C, A1C goal, and treatment on A1C goal attainment, the likelihood of A1C goal attainment decreased as distance to goal at baseline increased (Table). Compared to MET increase alone, MET increase + SITA was generally more effective in achieving glycemic targets across a range of goals and baseline A1C. These results suggest that the distance to A1C goal should be considered throughout the process of MET up-titration to inform AHA intensification strategy, including the potential benefit of early SITA initiation. Disclosure M. Crutchlow: Consultant; Spouse/Partner; Crinetics, Novartis Pharmaceuticals Corporation, ProSciento, Soleno Therapeutics, Zealand Pharma A/S. Employee; Self; Merck & Co., Inc. Research Support; Spouse/Partner; Dexcom, Inc. J. Lin: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. R.L. Lam: Employee; Self; Merck & Co., Inc. E.A. O9Neill: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. K.D. Kaufman: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. S.S. Engel: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. Funding Merck & Co., Inc.