Vildagliptin as good as metformin in controlling blood sugar in diabetes

Delhi: Vildagliptin or metformin showed similar protective effects on the beta-cell function, reduced insulin resistance, and blood sugar levels in newly diagnosed Asian Indians with type 2 diabetes (T2D), according to a recent study. The study further found that there was an improved insulin sensitivity in patients treated with metformin. 

The findings of the study were presented at the American Diabetes Association 80th Scientific Sessions held from June 12-16, 2020. The study was subsequently published in the journal Diabetes.

Vildagliptin, a dipeptidyl peptidase-4 (DPP4) inhibitor, is used for the treatment of type 2 diabetes. It is given as a second-line pharmacological treatment for diabetes patients who have not achieved the required lowering of blood sugar and HbA1c with metformin. 

Krishnamoorthy Satheesh from Chennai, India, and colleagues conducted the study to compare the effect of vildagliptin versus metformin on pancreatic beta-cell function among newly diagnosed, non-obese Asian Indians with T2D in 2 years. 

For the purpose, they conducted a randomized, multicentric, controlled, parallel-group study. The drug-naive diabetes patients were given the treatment with vildagliptin or metformin. The patients had baseline HbA1c - 7.0 - 8.5% and body mass index (BMI) < 25kg/m2. The researches measured plasma glucose, insulin, HbA1c, and C-peptide at intervals of 6 months for 2 years. 203 T2D patients (104 men and 99 women) were randomized into two groups. Group 1 was treated with metformin, 500mg - 2000mg (n = 100), and group 2, with vildagliptin 100mg (n = 103).

Key findings of the study include:

• In the metformin group 36% and in the vildagliptin group 27.2 % required only monotherapy for a median duration of 48 weeks (25 - 70 weeks).

• At the end of the study, changes in the area under the curve of insulin to glucose were non-significant in both groups.

• There were no changes in the postprandial C-peptide. Reduction in insulin resistance (HOMA-IR) was similar in both groups.

• Insulin sensitivity (Matsuda Index) increased significantly at 6 and 12 months with metformin but no change was seen in the vildagliptin group.

• The HbA1c level decreased significantly in both groups until 18 months.

• The fasting blood sugar decreased significantly till 12 months in both groups.

• Postprandil blood sugar decreased only with vildagliptin till 12 months.

• Occurrences of adverse events were similar in both groups.

• Higher C-peptide and lower HbA1c values at the baseline predicted better blood sugar control with vildagliptin. Lower baseline HbA1c predicted good glycemic control with metformin.

"Both metformin and vildagliptin had similar protective effects on the beta-cell function, reduced insulin resistance and glycemic levels. Improved insulin sensitivity was seen with metformin," concluded the authors. 

The study, "Comparative Assessment of the Effect of Vildagliptin and Metformin on Pancreatic Beta-Cell Function and Insulin Sensitivity in Newly Diagnosed Asian Indians with Type 2 Diabetes," is published in the journal Diabetes.

DOI: https://doi.org/10.2337/db20-970-P