A Comparative Evaluation of Safety, Efficacy and Cost Effectiveness of Three add on Treatment Regimens in Type 2 Diabetics; not Controlled by Metformin Alone

Abstract

Background and objectives: Type 2 diabetes mellitus (T2DM) is progressive multisystem disease requiring multiple antihyperglycaemic agents to attain or maintain glycaemic control. With the increase in incidence of T2DM and availability of a number of drugs as second line therapy there is considerable increase in the use of newer, more costly oral hypoglycaemic agents, which has resulted in substantial increase in associated costs to patients. The present study was aimed to evaluate the safety, efficacy and cost effectiveness of oral antidiabetic regimens. Methods: This study was an observational, prospective and longitudinal in nature carried out to study the safety, efficacy and cost effectiveness of three add on treatment regimens [i.e with sulfonylurea (group 1), glitazones (group 2) and dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) (group 3)] in patient with T2DM not controlled by metformin alone which included 150 subjects (approximately 50 patient in each group). The comparisons were conducted between these three groups for glycosylated haemoglobin (HbA1c), fasting plasma glucose (FPG), post prandial glucose (PPG), costs and lipid profile. Results: At week 12, the significant reduction in HbA1c was found in group 1 (-1.19%) when compared to group 2 (-0.71%) and group 3 (-0.70%). Also significantly greater reductions were observed in group 1 in FPG level (-38.88%) when compared to group 3 and in PPG level (-54.08%) when compared to group 2 and group 3. Comparison of three groups showed significant increase in the cost in group 3 as compared to group 1 and group 2, with the highest cost effectiveness measured in group 1 (p<0.0001). Interpretation and conclusions: Group 1 resulted in significantly greater reductions in HbA1c, FPG and PPG levels and highest cost effectiveness when compared with group 2 and group 3 in patients with T2DM.