Why carry out this study?

Metformin is the recommended initial treatment in type 2 diabetes mellitus (T2DM), and when this does not give adequate glucose control the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) guidelines provide second-line therapy recommendations based on the presence of established chronic kidney disease, heart failure or atherosclerotic cardiovascular disease.

The majority of people with T2DM do not have these comorbidities, and for these people there is uncertainty within the clinical community around the optimal choice of second-line treatment, as none have been found to have a better overall glycaemic response.

In this study, the real-world efficacy profiles of dipeptidyl peptidase 4 inhibitors (DPP4i), sulphonylureas (SU), thiazolidinediones (TZD) and sodium glucose co-transporter 2 inhibitors (SGLT2i) following metformin monotherapy were examined in terms of glycaemic control as a function of baseline phenotypic characteristics at second-line initiation.

What was learned from the study?

The study found little difference in the glycaemic effects of the different drug classes at 6 and 12 months.

However, patients’ age may have the potential to influence treatment response. In addition, other phenotypic characteristics such as gender, body mass index, estimated glomerular filtration rate (eGFR) and duration of T2DM may also be associated with HbA1c response but further research is required to examine these trends.

Accounting for specific demographic and clinical characteristics in clinical treatment decisions will enable better targeting of second-line regimens according to a person’s individual profile to achieve optimal clinical outcomes.