Comparative Effectiveness of Dipeptidyl Peptidase-4 Inhibitors versus Sulfonylurea as add-on Therapy to Metformin in Type 2 Diabetes Mellitus Patients: An Indonesian Real World Study

The aims of this study was to compare effectiveness of combination therapy metformin+dipeptidyl peptidase-4 inhibitor (DPP-4i) and metformin+sulfonylurea in terms of the achievement level of the HbA1c in Indonesian type 2 diabetes mellitus patients at Hospital. This study was an cohort retrospective with primary data obtained from electronic medical record and semi structured questionnaire prospectively. Propensity score matching (PSM) was used to generate comparable cohorts to perform outcome analysis. Generalized Linear Model-Repeated Measure (GLM-RM) analysis were used to examine the effect of combination therapy on HbA1c in each observation period. Total sample of 90 outpatients with T2DM fulfill inclusion criteria and based on PSM analysis showed that intervention (60 patients) and comparator (30 patients) groups are matching. GLM-RM analysis showed that there was an effect of the two drug groups on the HbA1c level in T2DM patients. The Partial Eta Squared level indicates that the multivariate analysis carried out can explain the variation of HbA1c by 87.2%. DPP-4i produce 0.63% reduction in HbA1c level compared to sulfonylurea as add-on therapy to metformin among Indonesian T2DM patient, in baseline without covariate. This DPP-4i effectiveness is followed by a lower incidence of hypoglycemia and weight loss.