Comparing Effect of Sitagliptin versus Empagliflozin as Add on Therapy to Metformin in Patients with Type 2 Diabetes Mellitus

Abstract

Background: Type 2 Diabetes Mellitus (T2DM) presents a substantial health challenge. Metformin is established as a standard treatment. This study evaluates sitagliptin, a dipeptidyl peptidase-4 inhibitor, and empagliflozin, a sodium-glucose cotransporter-2 inhibitor, as adjunct therapies to improve T2DM management. Objective: To compare effect of sitagliptin versus empagliflozin as add on therapy to metformin in patients with T2DM. Study Design: It was a prospective comparative study. Settings: This study was conducted at the Department of Medicine, DHQ Teaching Hospital, KMU Institute of Medical Sciences, Kohat Pakistan. Duration: 6 months period from March-September, 2023. Methods: A sample size of 100 cases was randomly assigned to either Group A or Group B. In conjunction with the standard metformin regimen (1000 mg twice daily), eligible patients were randomly assigned in a 1:1 ratio to receive either 50 mg of sitagliptin (Group A) or 12.5 mg of empagliflozin (group B) twice daily over 12 weeks. Study visits were scheduled at screening, weeks 0, and 12 of therapy, with no permitted dosage adjustments for the investigational drug. All the data was collected in a predesigned format and data analysis was done using SPSS 27.0. Results: Mean age of the patients in this study was 52.58±10.0 years in which 43.0% (n=43) participants were male while remaining 57% (n=57) were females. Both the groups were comparable with each other and did not possess any inherit difference between them with regard to all baseline characteristics (p-value >0.05. After three months mean HbA1C in group B was significantly less than group A (8.00±0.13 vs. 7.42±0.08%; p-value=0.000). Mean change in HbA1c at three months from the values at presentation was significantly high in group B than group A (-0.70±0.25 vs. -1.33±0.17%; p-value=0.000). Comparison of mean weight between the groups shows significantly less mean weight in group B at three months than group A (64.14±4.25 vs. 61.84±4.89 kg; p-value=0.014). Mean change in weight at three months was significantly high in group B than group A. When mean change in HbA1C and mean reduction in weight in both the groups was stratified for age and gender, it produced same significance for all the stratifications (p-value=0.000). Conclusion: In conclusion, our study reveals that empagliflozin leads to superior glycemic control and greater weight reduction compared to sitagliptin as add on therapy to metformin in patients T2DM. These findings emphasize the potential benefits of individualized treatment strategies for optimized outcomes in T2DM management.