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Swapnil N. Rajpathak Part 1, DPP-4 Inhibitors and Hypoglycemia

In part 1 of this Exclusive Interview, Dr. Swapnil N. Rajpathak talks with Diabetes in Control Publisher Steve Freed during the ADA 2017 Scientific Sessions in San Diego, CA about the contribution of the DPP4’s to the reduction of hypoglycemic risk.

Swapnil N. Rajpathak, MD, MPH, DrPH is Executive Director for the Center for Observational and Real World Evidence at Merck.


Transcript of this video segment:

Steve: This is Steve Freed with Diabetes in Control. And we are here at the American Diabetes Association 77th scientific session, 2017. And we are here to present to you some really exciting interviews with some of the top endos from all over the world. Here we have Dr Rajpathak. Tell me little bit about yourself. We met last year but people won’t remember what you said. Let’s talk a little bit about who you are, what you do, and why you are here.

Swapnil: Thank you, Steve. First of all, thank you for your time and opportunity to talk to you today. We are really excited here to be at ADA. We have several abstracts here so I belong to a group within Merck, which focuses on outcomes research and real world evidence. The group is called Core Center for Observational and Real World Evidence. And we are here to present several abstracts that support the research that we do in diabetes in several different areas, including hypoglycemia, comorbidities, and epidemiology in patients with diabetes and many more research projects that will be presented here at ADA this year.

Steve: And which ones are you responsible for?

Swapnil: So we have several abstracts for real world. All of them I am responsible for.

Steve: Basically the real world abstracts are the ones that you are comfortable with.

Swapnil: Absolutely.

Steve: You said 3 abstracts. What’s the difference between the 3 or what are the 3 abstracts?

Swapnil: There are actually more than 10 abstracts, but if I have to categorize areas of research I would say that there are several on hypoglycemia, there are some on clinical inertia, which we spoke last year. We had studies at that time as well. And then we have some other abstracts that are focused on different aspects of diabetes research, including epidemiology of patients with diabetes in terms of their comorbidities. I can speak to few of them if you would like

Steve: Please.

Swapnil: The specific one I would like to discuss, Steve, is the one we are presenting right now at the poster session. It’s a study that we did to understand what is the contribution of the DPP4’s to the reduction of hypoglycemic risk when they were launched in 2007. So over the last 10 year period, as you know, that DPP4’s have been used in the market very commonly. Not just DPP4s but other drugs like sulfonylureas have also been used in management of diabetes and are still continued to be used. Hypoglycemia is commonly known with drugs like sulfonylureas while newer drugs like DPP4s are known to have much lower risk of hypoglycemia. So over the last 10-year period, we wanted to understand if additional use of DPP4s have resulted in any reduction in hypoglycemia events in patients with diabetes and to the healthcare system. So we started with the commercial claims database in the US. It’s called market scan. And we tried to understand hypoglycemia rates in last several years. So, we looked at data from 2007 to 2013 and tried to understand what is hypoglycemia risk over a period of time among patients that are newly initiated either a sulfonylurea or a DPP4. And within the one year, we identified events of hypoglycemia based on a known algorithm. And we found that throughout this time period, patients with SU’s have almost double the hypoglycemic event compared to patients on DPP4s. So, using that data…

Steve: Well, let me stop you for a second. You’re comparing hypoglycemia rate of DPP4 to what?

Swapnil: to sulfonylureas. Over the time period of 7 years, we looked at rates of each year. The next thing we did was to understand characteristics and the risk factors of hypoglycemia among SU’s users. And based on that, we created a predicted model and applied it to DPP4 users. That helps us to understand, what would have happened if all the DPP4 users would have gotten on a sulfonylurea instead? If DPP4 had not launched, if all these patients had gotten on SUs, what would have been the hypoglycemia rate in the US? And interestingly we found that DPP4’s contributed to approximately 50% reduction in hypoglycemic events during this time period. As you know, hypoglycemia is not just associated with quality of life and clinical management of patients but also has economic burden related to the healthcare system. Because of the added cost due to hypoglycemia, reducing the events of hypoglycemia would have a substantial benefit in terms of cost savings. And that was the purpose of this research.

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