Harmful versus beneficial effects of using short-term combined oral antidiabetic therapy: ‎An open label comparative clinical trial ‎

Abstract

Background: Although oral antidiabetic drugs have many beneficial pleiotropic effects, they are ‎not free from adverse reactions that may interfere with glucose homeostasis. This study aimed ‎to assess the effects of oral antidiabetic drugs as add- on-therapy to metformin, on the metabolic, ‎cardiac, and renal determinants. ‎ Material and methods: A total number of seventy-eight type 2 diabetes (T2D) patients who ‎were treated with metformin were allocated to add-on-therapy for 12 weeks, with glimepiride ‎‎(4mg/day, n=26), sitagliptin (100mg/day, n=28), and canagliflozin (300mg/day, n=24). ‎Anthropometric measurements, glycemic indices, lipid, and renal markers, were determined ‎before initiation and after the treatment. ‎ Results: All of the three treatments significantly decreased the glycemic indices, triglyceride-to-glucose index, and non-significantly altered the serum uric acid-to creatinine. Glimepiride ‎significantly increased the waist-to-height ratio (0.630±0.057 versus 0.640±0.057, p=0.040), ‎while sitagliptin and canagliflozin significantly decreased it (0.650±0.058 versus 0.640±0.054, ‎p=0.009, and 0.650±0.041 versus 0.630±0.044, p<0.001). Estimated glomerular filtration index- ‎epidemiology collaboration (ml/min/1.73m2) significantly declined by using glimepiride ‎‎(109.0±10.4 versus 103.6±10.9, p=0.001), and sitagliptin (106.1±12.4 versus 103.3±15.0, ‎p=0.013). ‎ Conclusion: Careful selection of using oral antidiabetic agents can protect T2D patients from ‎harmful events, particularly those related to cardiovascular events and renal function‎