Remission of Type 2 Diabetes Following a Short-term Intensive Intervention With Insulin Glargine, Sitagliptin, and Metformin: Results of an Open-label Randomized Parallel-Design Trial.

Abstract

OBJECTIVE:

The aim of the study was to evaluate remission of type 2 diabetes following a short-term intervention with insulin glargine, sitagliptin/metformin, and lifestyle approaches.

RESEARCH DESIGN AND METHODS:

In this open multicenter trial, 102 patients with type 2 diabetes were randomized to 1) a 12-week intervention with sitagliptin/metformin, insulin glargine, and lifestyle therapy or 2) control group. Participants with HbA1c <7.3% (<56 mmol/mol) at 12 weeks were asked to stop diabetes medications and were followed for evidence of relapse over 52 weeks. Diabetes relapse criteria included HbA1c ≥6.5% (≥48 mmol/mol), ≥50% of capillary glucose readings >10 mmol/L over 1 week, and reinitiation of diabetes medications with or without abnormal fasting plasma glucose (FPG) or 2-h plasma glucose on an oral glucose tolerance test (OGTT). Time-to-relapse analysis was conducted to compare the treatment groups with (primary analysis) and without (supplementary analysis) FPG/OGTT relapse criteria.

RESULTS:

With the FPG/OGTT relapse criteria included, the hazard ratio (HR) of relapse was 0.72 (95% CI 0.47-1.10) in the intervention group compared with the control group (primary analysis), and the number of participants remaining in remission was not significantly different between treatment groups at 24, 36, 48, and 64 weeks. In the supplementary analyses without these criteria, HR of relapse was 0.60 (95% CI 0.39-0.95), and the number of participants remaining in remission was significantly higher (26 vs. 10%) in the intervention group at 36 weeks.

CONCLUSIONS:

Although our primary outcome was not statistically significant, the tested approach deserves further study with further optimization of its components.

• Authors: Natalia McInnes, Stephanie Hall, Irene Hramiak, Ronald J Sigal, Ronald Goldenberg, Nikhil Gupta, Remi Rabasa-Lhoret, Manoela Braga, Vincent Woo, Farah Sultan, Rose Otto, Ada Smith, Diana Sherifali, Yan Yun Liu, Hertzel C Gerstein, REMIT-sita Collaborative Group
• Journal: Diabetes care (Diabetes Care) Vol. 45 Issue 1 Pg. 178-185 (01 01 2022) ISSN: 1935-5548 [Electronic] United States
• PMID: 34728531 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 by the American Diabetes Association.

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin Glargine
• Metformin
• Sitagliptin Phosphate

Topics

• Blood Glucose
• Diabetes Mellitus, Type 2
• Drug Therapy, Combination
• Glycated Hemoglobin
• Humans
• Hypoglycemic Agents (therapeutic use)
• Insulin Glargine (therapeutic use)
• Metformin (therapeutic use)
• Sitagliptin Phosphate (therapeutic use)
• Treatment Outcome