Saxagliptin/dapagliflozin is non‐inferior to insulin glargine in terms of β‐cell function in subjects with latent autoimmune diabetes in adults: A 12‐month, randomized, comparator‐controlled pilot study

• Published in: Diabetes, obesity & metabolism obesity & metabolism, 2024-05, Vol.26 (5), p.1670-1677
• Main Authors: Maddaloni, Ernesto, Naciu, Anda M., Mignogna, Carmen, Galiero, Raffaele, Amendolara, Rocco, Fogolari, Marta, Satta, Chiara, Serafini, Chiara, Angeletti, Silvia, Cavallo, Maria Gisella, Cossu, Efisio, Sasso, Ferdinando Carlo, Buzzetti, Raffaella, Pozzilli, Paolo
• Format: Article
• Language: English
• Subjects: Adamantane - analogs & derivatives; Adult; Antidiabetics; Autoimmune diseases; Benzhydryl Compounds; Beta cells; Blood Glucose; Body mass index; C-Peptide; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - drug therapy; Dipeptides; Double-Blind Method; DPP‐4 inhibitors; Drug Therapy, Combination; Glucosides; Glycated Hemoglobin; Hemoglobin; Humans; Hypoglycemic Agents - adverse effects; Insulin; Insulin Glargine - adverse effects; LADA; Latent Autoimmune Diabetes in Adults; Metformin; Metformin - therapeutic use; Peptides; Pilot Projects; SGLT2 inhibitors; Treatment Outcome; β‐cell function
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.15469

Aim To compare the efficacy and safety of saxagliptin/dapagliflozin and insulin glargine in people with latent autoimmune diabetes in adults (LADA). Methods In this phase 2b multicentre, open‐label, comparator‐controlled, parallel‐group, non‐inferiority study, we randomly assigned 33 people with LADA who had a fasting C‐peptide concentration ≥0.2 nmol/L (0.6 ng/mL) to receive 1‐year daily treatment with either the combination of saxagliptin (5 mg) plus dapagliflozin (10 mg) or insulin glargine (starting dose: 10 IU), both on top of metformin. The primary outcome was the 2‐h mixed meal‐stimulated C‐peptide area under the curve (AUC), measured 12 months after randomization. Secondary outcomes were glycated haemoglobin (HbA1c) levels, change in body mass index (BMI), and hypoglycaemic events. Results In the modified intention‐to‐treat analysis, the primary outcome was similar in participants assigned to saxagliptin/dapagliflozin or to insulin glargine (median C‐peptide AUC: 152.0 ng*min/mL [95% confidence interval {CI} 68.2; 357.4] vs. 122.2 ng*min/mL [95% CI 84.3; 255.8]; p for noninferiority = 0.0087). Participants randomized to saxagliptin/dapagliflozin lost more weight than those randomized to insulin glargine (median BMI change at the end of the study: −0.4 kg/m2 [95% CI −1.6; −0.3] vs. +0.4 kg/m2 [95% CI −0.3; +1.1]; p = 0.0076). No differences in HbA1c or in the number of participants experiencing hypoglycaemic events were found. Conclusions Saxagliptin/dapagliflozin was non‐inferior to glargine in terms of β‐cell function in this 12‐month, small, phase 2b study, enrolling people with LADA with still viable endogenous insulin production. Weight loss was greater with saxagliptin/dapagliflozin, with no differences in glycaemic control or hypoglycaemic risk.