Effect of Switching from Linagliptin to Teneligliptin Dipeptidyl Peptidase-4 Inhibitors in Older Patients with Type 2 Diabetes Mellitus

Eugene Han,1 Minyoung Lee,2 Yong-ho Lee,2– 4 Hye Soon Kim,1 Byung-wan Lee,2– 4 Bong-Soo Cha,2– 4 Eun Seok Kang2– 4 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; 3Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea; 4Severance Hospital Diabetes Center, Yonsei University College of Medicine, Seoul, Republic of KoreaCorrespondence: Eun Seok KangDivision of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of KoreaTel +82 2 2228 1938Fax +82 2 393 6884Email edgo@yuhs.acIntroduction: Dipeptidyl peptidase-4 (DPP-4) inhibitors are widely prescribed for type 2 diabetes (T2D) and their glycemic control effects are well studied. However, information regarding the effects of switching DPP-4 inhibitors is limited, especially in older patients.Research Design and Methods: We investigated whether switching from linagliptin to teneligliptin decreases blood glucose in older (≥ 65 years) T2D patients. In total, 164 patients with T2D who switched from linagliptin to teneligliptin for > 12 weeks were included and the primary outcome was glycemic changes.Results: Switching from linagliptin to teneligliptin ameliorated fasting blood glucose (148.1 ± 47.1 to 139.6 ± 43.4 mg/dL), glycated hemoglobin (HbA1c; 7.9 ± 1.3 to 7.5 ± 1.2%), and postprandial blood glucose (224.8 ± 77.4 to 205.8 ± 70.8 mg/dL) levels (all P < 0.05). Low-density lipoprotein cholesterol concentration was reduced while liver and kidney functions were maintained. Subgroup analysis showed that glucose control improved more in patients with uncontrolled hyperglycemia (HbA1c > 8.0%) and chronic kidney disease (estimated glomerular filtration rate < 90 mL/min/1.73m2). Multiple logistic analysis indicated higher baseline HbA1c was the strongest predictor of teneligliptin switching response.Conclusion: Switching from linagliptin to teneligliptin helps maintain kidney function and reduce blood glucose safely in older patients with T2D.Keywords: dipeptidyl peptidase 4 inhibitor, linagliptin, teneligliptin, type 2 diabetes mellitus, older patients, chronic kidney disease