Abstract
BackgroundPatients with diabetes are at higher risk of developing polypharmacy because of the high frequency of comorbidities. There have been several reports on the hypoglycemic risk of the combination of hypoglycemic agents and other medications. This study aimed to investigate the hypoglycemic risk of drug-drug interaction between sitagliptin and other oral hypoglycemic agents or antihypertensive agents in Japanese patients with type 2 diabetes.MethodsFrom January 2010 to March 2012, a total of 3247 patients were recruited and evaluated at outpatient clinics at Juntendo University Hospital, other satellite hospitals, and private clinics. This study was a sub-analysis of the Sitagliptin Registration Type 2 Diabetes-Juntendo Collaborating Project. Participants were limited to those treated with oral hypoglycemic agents, excluding insulin users, to investigate the association of the first hypoglycemic events with oral hypoglycemic agents or other medications within 6 months after starting sitagliptin. The factors related to the first hypoglycemic event were analyzed using Cox regression analysis.ResultsIn total, 2956 patients with a mean age of 65.1 ± 11.3 years were included. A total of 46 hypoglycemic events (1.6%) were observed. One patient had severe hypoglycemia followed by emergency transport to the hospital. Sitagliptin was not associated with hypoglycemia, but its combination with sulfonylurea (hazard ratio: 4.42, 95% confidential interval: 1.36–14.42) or β-blocker (hazard ratio, 3.50, 95% confidential interval: 1.54–7.96) was significantly associated with hypoglycemia.ConclusionsThe drug-drug interactions between sitagliptin and sulfonylurea or β-blocker likely increases the hypoglycemic risk in Japanese patients with type 2 diabetes. Pharmacists should consider potential adverse events from drug-drug interaction in type 2 diabetes with polypharmacy, particularly those who are managed by several doctors or clinics.
Highlights
Patients with diabetes are at higher risk of developing polypharmacy because of the high frequency of comorbidities
Type 2 diabetes (T2DM) is associated with reduced quality of life (QOL) and shortened life expectancy associated with microvascular complications [3,4,5,6,7,8,9]
In a study conducted by the Japanese Society of Glucose and Diabetes to investigate severe hypoglycemia, insulin was responsible for approximately 60% of severe hypoglycemia in patients with T2DM [15]
Summary
Patients with diabetes are at higher risk of developing polypharmacy because of the high frequency of comorbidities. T2DM is associated with reduced quality of life (QOL) and shortened life expectancy associated with microvascular complications [3,4,5,6,7,8,9]. It has been reported that maintaining good glycemic control reduces the risk of microvascular complications [11,12,13,14]. Previous clinical trials have failed to show the effects of intensive glycemic control on reducing the incidence of macrovascular complications [12, 14,15,16]. According to the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, intensive glucose-lowering therapy failed to reduce major cardiovascular events. The prevention of hypoglycemia is an important issue in the treatment of diabetes
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