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01-07-2012 | General practice | Article

Linagliptin an option in diabetes

Abstract

Lancet

2012; Advance online publication[p1]

MedWire News: Linagliptin could be an alternative option to a sulphonylurea as add-on therapy in patients with type 2 diabetes inadequately controlled by metformin.

A study published in The Lancet showed that linagliptin was as effective as glimepiride in lowering patients' HbA1c, while being associated with less hypoglycemia and causing weight loss rather than weight gain.

Linagliptin is one of the novel dipeptidyl peptidase-4 inhibitors that increase incretin levels, which inhibits glucagon release, thereby increasing insulin, reducing gastric emptying and reducing glucose levels.

The 2-year, double-blind randomised trial in over 1500 patients showed that patients who received linagliptin 5 mg once daily had a similar reduction in HbA1c, of 0.16%, to those who received glimepiride 1‑4 mg daily, whose HbA1c levels fell by 0.36% on average.

However, the rate of hypoglycemia was five times lower with linagliptin than with glimepiride, at respective rates of 7% versus 36%.

Furthermore, patients' body weight decreased with linagliptin, by an average of 1.6 kg, whereas it increased with glimepiride, by 1.3 kg.

Fewer patients had cardiovascular events in the linagliptin group, at 12 compared with 26 patients in the glimepiride group, although the authors stress that this could be due to chance as the study was not primarily designed to look at this outcome.

"Our findings support the use of linagliptin in combination with metformin as a therapeutic option for treatment of type 2 diabetes," write Professor Baptist Gallwitz (University of Tübingen, Germany) and colleagues. This "could improve decision making for clinical treatment when metformin alone is insufficient", they say.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Caroline Price