OBJECTIVES: Metformin failure is common in clinical practice among T2DM patients. There is a therapeutic dilemma regarding choice of appropriate add on medications, particularly in low-income settings. We carried out a real-world comparative effectiveness analysis between glimepiride and teneligliptin, two commonly prescribed relatively newer and cheaper add on drugs in India as such a head-to-head comparison has not been documented.

METHODS: Adult T2DM patients with inadequately controlled glyacemia (HbA1c ≥ 7 %, or FBS ≥ 140 mg/dl) with standard metformin monotherapy and adequate adherence were recruited in this prospective observational cohort study. They were prescribed either Glimepiride 2 – 4 mg or teneligliptin 20 mg daily as the add on drugs. Glycaemic efficacy, adherence and other parameters along with safety were recorded at follow up visits at least once within 6 months.

RESULTS: This interim analysis was done on 64 enrolled patients (males 58%, females 32%) including 24 in glimepiride group and 40 in teneligliptin group. Median follow up duration among patients in both groups was 4 months. Mean reduction in HbA1c in patients receiving glimepiride was 2.23 ± 1.62 % (p = 0.0003) as compared to 1.06 ± 1.36 % in teneligliptin group (p = 0.002). HbA1c reduction was quite variable but significantly greater with glimepiride group compared to teneligliptin (p = 0.03). The proportion of patients achieving adequate glycaemic control (based on HbA1c and/or FBS) was also higher (46.2 %) with glimepiride compared to teneligliptin (32 %). Mean change in weight was + 1.14 and - 0.21 kg in the glimepiride and teneligliptin groups respectively. Similar proportion of patients (15 – 16%) reported adverse events in both groups.

CONCLUSIONS: Interim results show that glimepiride is a more effective add-on treatment option after metformin with similar safety as compared to teneligliptin. Further continuation of the study with higher sample size shall validate the results.