Comparative Effectiveness of DPP-4 Inhibitors Versus Sulfonylurea for the Treatment of Type 2 Diabetes in Routine Clinical Practice: A Retrospective Multicenter Real-World Study

Carla Giordano, Manfredi Rizzo, Ivano Franzetti, Olga Lamacchia, Alessandra Dei Cas, Ileana Baldi, Fabrizio Querci, Gian Pio Sorice, Vera Frison, Nino Cristiano Chilelli, Gaetano Leto, Giovanni Grossi, Edoardo Duratorre, Carmela Vinci, Carlo Mannina, Patrizia Li Volsi, Giuseppe Capobianco, Federica D’Angelo, Giuseppe Saglietti, Massimiliano PetrelliGiuseppe Felace, Maurizio Poli, Achiropita Pucci, Salvatore Piro, Salvatore Arena, Silvestre Cervone, Roberta Chianetta, Paola D’Angelo, Daniele Bottigliengo, Carla Giordano, Ioannis Karamouzis, Bruno Fattor, Paola Silvia Morpurgo, Gian Paolo Fadini, Ioannis Karamouzis, Natalino Simioni, Bruno Fattor, Roberto Anichini, Paola Silvia Morpurgo, Francesco Andreozzi, Gianluca Aimaretti, Lucia Frittitta, Ivana Zavaroni, Giuseppe Penno, Emanuela Orsi, Franco Cavalot, Susanna Morano, Antonino Di Benedetto, Enzo Bonora, Massimo Boemi, Giorgio Sesti, Angelo Avogaro, Annunziata Lapolla, Raffaella Buzzetti, Anna Solini, Riccardo Bonadonna, Massimo Cigolini, Antonio Carlo Bossi, Adriano Gatti, Agostino Consoli, Manfredi Rizzo, Giuliana Cazzetta, Gloria Formoso, Giancarlo Zatti, Eleonora Devangelio, Carlo Mannina, Roberta Chianetta

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Introduction: DPP-4 inhibitors (DPP4i) and sulfonylureas are popular second-line therapies for type 2 diabetes (T2D), but there is a paucity of real-world studies comparing their effectiveness in routine clinical practice. Methods: This was a multicenter retrospective study on diabetes outpatient clinics comparing the effectiveness of DPP4i versus gliclazide extended release. The primary endpoint was change from baseline in HbA1c. Secondary endpoints were changes in fasting plasma glucose, body weight, and systolic blood pressure. Automated software extracted data from the same clinical electronic chart system at all centers. Propensity score matching (PSM) was used to generate comparable cohorts to perform outcome analysis. Results: We included data on 2410 patients starting DPP4i and 1590 patients starting gliclazide (mainly 30–60 mg/day). At baseline, the two groups differed in disease duration, body weight, blood pressure, HbA1c, fasting glucose, HDL cholesterol, triglycerides, liver enzymes, eGFR, prevalence of microangiopathy, and use of metformin. Among DPP4i molecules, no difference in glycemic effectiveness was detected. In matched cohorts (n = 1316/group), patients starting DPP4i, as compared with patients starting gliclazide, experienced greater reductions in HbA1c (− 0.6% versus − 0.4%; p < 0.001), fasting glucose (− 14.1 mg/dl versus − 8.8 mg/dl; p = 0.007), and body weight (− 0.4 kg versus − 0.1 kg; p = 0.006) after an average 6 months follow-up. DPP4i improved glucose control more than gliclazide, especially in patients who had failed with other glucose-lowering medications or were on basal insulin. Conclusions: This large retrospective real-world study shows that, in routine clinical practice, starting a DPP4i allows better glycemic control than starting low-dose gliclazide. Funding: The Italian Diabetes Society, with external support from AstraZeneca.
Original languageEnglish
Pages (from-to)1477-1490
Number of pages14
JournalDiabetes Therapy
Publication statusPublished - 2018

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism


Dive into the research topics of 'Comparative Effectiveness of DPP-4 Inhibitors Versus Sulfonylurea for the Treatment of Type 2 Diabetes in Routine Clinical Practice: A Retrospective Multicenter Real-World Study'. Together they form a unique fingerprint.

Cite this