Prof. Groop (Helsinki, Finland)

It is also important to consider how linagliptin works when you combine it with other medications. I’ve already shown you in combination with metformin but this slide shows, on the left-hand side, monotherapy, you can see that it ranges from 0.6% to 0.9% reduction; maybe slightly more pronounced effect in the Japanese population and this is something we have seen earlier that linagliptin might be, and also the other DPP4 inhibitors, might be more effective in the Asian population. And here in the middle you can see dual combination: add-on to metformin, add-on to sulphonylureas or add-on to pioglitazone, you can see that you can expect a similar reduction. And on the right‑hand side, triple combination, similar effect and even add-on to insulin. So, this gives us some idea that whenever you use linagliptin and combine it with any other medication, you can expect an additional between 0.6–0.7% reduction in A_1c , which is, of course, very important when we try to strive for optimal glycaemic control.

What about then if you have a lean patient in front of you or you have an obese patient, what is the effect of linagliptin? This slide shows that the effect is exactly the same whether the patient is lean or obese and, of course, also shown in this slide: when combined with metformin the effect is slightly better, and that is, of course, was already shown in one of the previous slides. But the good news here is that irrespective of body mass index, you can expect the same effect.

If you then look at the age of the patients, left-hand side, below 50 [years old] and right-hand side above 75 years, you can see again a similar effect: 0.6–0.7% reduction in A_1c . So, basically, whatever the characteristics behind [the patient] we can expect the same effect.

This is also shown here when you look at the duration of diabetes, less than 1 year or more than 5 years, again similar effect: 0.5–0.7% reduction [in A_1c ].

This is patients with a long history of T2D, about 10 years, and you can see, compared to placebo: 0.66% reduction in A_1c . On the right-hand side, the percentage of patients achieving target A_1c in those that have had diabetes for more than 10 years is better with linagliptin compared with placebo and, again, very similar effect: 0.6–0.7% reduction of A_1c . That is what you can expect if your baseline is around 8%.

What about then different ethnicities? This slide shows that whether you are black/African American (in the middle), Asian or (on the right-hand side) Hispanic, again very similar effects; so, basically what I’m showing you – very boring results because they are all the same, but it also makes it so simple and the theme of today is simplicity of linagliptin.

This slide shows that it’s also the efficacy stays, remains consistent across all stages of kidney function. I’m a nephrologist, so this is, of course, for me extremely important to see that if I prescribe a drug, that you will see the same effect whether the patient has normal kidney function or even severe kidney function and, you know, linagliptin is basically the only DPP4 inhibitor and also one of the few that you can prescribe to a patient on dialysis. This is, of course, also makes it a simple choice for all patients with T2D.