OBJECTIVES: Between 2015 and 2019, a private health insurer in Colombia started using two new groups of oral antidiabetics: iDPP4 (sitagliptin, vildagliptin, saxagliptin, linagliptin) or iSGLT2 (dapagliflozin, canagliflozin and empagliflozin). The objective was to analyze clinical outcomes and costs of patients in the year before and after the new medication was introduced.

METHODS: All adult patients (18 years of age or older) who were prescribed any of the drugs of interest, had information of the year prior to initiation and had a follow-up of at least a year after prescription were included. Clinical variables (glycated hemoglobin, severe side effects, hospitalizations) were obtained from electronic medical records. Direct medical costs from a third-party payer perspective (the health insurer) were converted from Colombian pesos (COP) to US dollars (USD) at official exchange rate for 2028 (1 USD = 2,957 COP).

RESULTS: Of a total of 46,618 type 2 adult diabetic patients, 18,323 fulfilled inclusion criteria. All antidiabetics were effective: the median decrease in glycated hemoglobin was 1.05 for iSGLT2, and 0.81 for iDPP4. Proportion of patients that accomplished ≤7.0 HbA1c also improved, from 14% to 36.2% for iSGLT2, and from 17% to 38.5% for iDPP4. There was no difference in mortality rate between both groups. The annual weighted cost to decrease glycated hemoglobin by 1% for iSGLT2 was USD 422, and USD 330 for iDPP4. In the iSGLT2 group there was a reduction in hospitalization rates (number needed to treat- NNT: 44) and and in the incidence of coronary heart disease (NNT: 46). In the iDPP4 group NNTs were larger for hospitalization (NNT: 178) but also decreased incidence of acute renal failure (NNT: 631).

CONCLUSIONS: Both pharmacological groups were effective, with no significant increase in side effects. Clinical results in this cohort are consistent with those published in clinical trials and meta-analyses.