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Metformin plus a dipeptidyl peptidase‐4 inhibitor (DPP‐4i) is the most common therapy for Japanese patients with type 2 diabetes. This 24‐week, multicentre, open‐label, parallel‐group trial randomized patients on dual therapy to add‐on tofogliflozin (20 mg/day, n = 33) or glimepiride (0.5 mg/day, n = 31). The primary outcome was change in body fat percentage. The secondary outcomes included changes in HbA1c, fat mass, fat‐free mass, liver function variables and uric acid. Tofogliflozin and glimepiride reduced HbA1c to a similar extent. Body fat percentage did not change from baseline in either group. Fat mass was reduced by tofogliflozin but was increased by glimepiride (by −2.0 ± 1.7 kg and +1.6 ± 1.6 kg,  P  = .002). Fat‐free mass was also reduced by tofogliflozin and increased by glimepiride (by −1.3 ± 1.3 kg and +0.9 ± 2.0 kg,  P  < .001). Alanine aminotransferase and uric acid levels were reduced by tofogliflozin ( P  = .006 and  P  < .001, respectively). These data provide novel information useful for selecting the third oral agent for patients whose diabetes is inadequately controlled with metformin plus DPP‐4i dual therapy.

diabetes, obesity and metabolism

Comparison of tofogliflozin versus glimepiride as the third oral agent added to metformin plus a dipeptidyl peptidase‐4 inhibitor in Japanese patients with type 2 diabetes: A randomized, 24‐week, open‐label, controlled trial ( STOP‐OB )