Patient stratification for determining optimal second-line and third-line therapy for type 2 diabetes: the TriMaster study
Authors' conclusion
In this precision medicine trial in type 2 diabetes, our findings support the use of simple, routinely available clinical measures to identify the drug class most likely to deliver the greatest glycemic reduction for a given patient.
Study context
- Population
- People with T2D on metformin alone or metformin plus SU, UKcrossover
- Participants
- 525 people
- Comparison
- Sitagliptin vs canagliflozin vs pioglitazone, 16 weeks each, added to metformin ± SU
- Primary endpoint
- Achieved HbA1c difference between strata for the two drugs (for both hypotheses)
- Follow-up
- 16 weeks of treatment with each drug
Methodological detailsdouble-blind, three-way crossover, UK-based
- Double-blind
- Three-way crossover
- UK-based
Primary result
As reported in the abstract
Achieved HbA1c difference between strata for the two drugs
Estimate (95% CI)P value
Pioglitazonevs Sitagliptinlower HbA1c on pioglitazone than sitagliptin in BMI >30; n = 356
difference in achieved HbA1c, BMI >30 vs ≤30 kg/m² 2.88 mmol/mol(0.98–4.79)
P = 0.003Sitagliptinvs Canagliflozinlower HbA1c on sitagliptin than canagliflozin in eGFR 60-90; n = 342
difference in achieved HbA1c, eGFR 60-90 vs >90 ml/min/1.73 m² 2.90 mmol/mol(1.19–4.61)
P = 0.001Further findings
Achieved HbA1c overall — between Pioglitazone and Sitagliptin · three drugs compared; similar
P = 0.2
Achieved HbA1c overall
- Achieved HbA1c similar for the three drugs
Safety
- Adverse events reported
- 2,201
- Randomized participants with an adverse event on at least one study drug
- 447/525 (85%)
Original publication
Patient stratification for determining optimal second-line and third-line therapy for type 2 diabetes: the TriMaster study. Nat Med. Published 7 December 2022. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →