title: Clinical and economical consequences of the combination of metformin with dipeptidyl peptidase inhibitors in type 2 diabetes patients.
abstract: OBJECTIVE
  There are different second line glucose lowering drugs whose efficacy, safety and economic profile have not been established in our setting. We have analyzed the clinical (diabetic treatment adherence, metabolic control, hypoglycemia and macrovascular complications) and economic (resource use and costs) consequences of the combination of metformin with dipeptidyl peptidase inhibitors (DPPIV) in patients with type 2 diabetes.
  
  
  METHODS
  We conducted a multicenter, observational and retrospective study. Patients ≥30 years treated with metformin who initiated a second antidiabetic treatment during 2008-2009 were enrolled in the study. Two groups of patients were established: a) metformin with DPPIV and metformin with other diabetic drugs. The main measurements were comorbidity, compliance/persistence, metabolic control (glycosylated hemoglobin <7%), complications (hypoglycemia, macrovascular) and total costs. Patients were followed-up for 2 years.
  
  
  RESULTS
  A total of 2,067 patients were enrolled (mean age: 66.6 years, 53.1% male). Of these, 519 patients (25.1%) were analyzed in the metformin+DPPIV group and 1,548 patients (74.9%) in the group metformin+other antidiabetic drug. The DPPIV group patients showed better compliance (70.3 vs. 59.6%), persistence (63.4 vs. 51.0%) and metabolic control (64.3 vs. 59.6%), respectively (P<.001) compared to the other group. They also showed a lower proportion of hypoglycemia (13.9 vs. 44.3%), cardiovascular events (3.7 vs. 7.6%) and total costs (2,347 vs. € 2,682), P<.05.
  
  
  CONCLUSIONS
  Despite the limitations of the study, patients treated with metformin associated to DPPIV were more likely to show increased adherence, metabolic control and lower rates of hypoglycemia than those treated with metformin associated to other antidiabetics.
authors.affiliation: Dirección de planificación, Badalona Serveis Assistencials SA, Badalona, Barcelona, España. Electronic address: asicras@bsa.cat.
authors.forename: A
authors.initials: A
authors.lastname: Sicras Mainar
authors.forename: C
authors.initials: C
authors.lastname: Roldán Suárez
authors.forename: B
authors.initials: B
authors.lastname: Font Ramos
authors.forename: R
authors.initials: R
authors.lastname: Navarro Artieda
authors.forename: J
authors.initials: J
authors.lastname: Ibáñez Nolla
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics*; D004152:Dipeptidyl-Peptidases and Tripeptidyl-Peptidases / Q000037:antagonists & inhibitors*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000191:economics*; D008297:Male; D008687:Metformin / Q000008:administration & dosage* / Q000191:economics*; D012189:Retrospective Studies
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin; D004152:Dipeptidyl-Peptidases and Tripeptidyl-Peptidases
keywords: Cardiovascular disease; Control metabólico; Costes sanitarios; DPPIV; Diabetes; Eventos cardiovasculares; Health care costs; Hipoglucemias; Hypoglycemia; IDPP4; Metabolic control