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Optimal candidates for the switch from glimepiride to sitagliptin to reduce hypoglycemia in patients with type 2 diabetes mellitus.

Kim HM, Lim JS, Lee BW, Kang ES, Lee HC, Cha BS - Endocrinol Metab (Seoul) (2014)

Bottom Line: We investigated the efficacy and safety of sitagliptin when patients switched from a sulfonylurea to sitagliptin and identified good candidates for the switch.Sixty-one patients with type 2 diabetes switched from glimepiride with metformin to sitagliptin with metformin due to clinical hypoglycemia.Patients with dominant insulin resistance may be good candidates for switching from a sulfonylurea to sitagliptin to reduce hypoglycemia.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Sitagliptin is a novel antidiabetic agent with a low risk for hypoglycemia. We investigated the efficacy and safety of sitagliptin when patients switched from a sulfonylurea to sitagliptin and identified good candidates for the switch.

Methods: Sixty-one patients with type 2 diabetes switched from glimepiride with metformin to sitagliptin with metformin due to clinical hypoglycemia. Serum glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2-hour postprandial plasma glucose (2h-PPG) before and 12 and 24 weeks after the drug switch were checked.

Results: HbA1c and FPG levels did not change 12 or 24 weeks after the switch; however, the 2h-PPG level decreased from 218.0±67.5 mg/dL at baseline to 197.1±69.9 mg/dL at 12 weeks and 192.3±67.4 mg/dL at 24 weeks after switching drugs (P=0.045, P=0.018, respectively). All but one patient no longer experienced hypoglycemia after discontinuing glimepiride. In a multivariate logistic regression analysis, a high homeostasis model assessment of insulin resistance and low baseline HbA1c level were independent predictors of an HbA1c ≤7% after switching to sitagliptin.

Conclusion: Glycemic control was not aggravated in patients 24 weeks after the drug switch, and symptomatic hypoglycemia decreased significantly. Patients with dominant insulin resistance may be good candidates for switching from a sulfonylurea to sitagliptin to reduce hypoglycemia.

No MeSH data available.


Related in: MedlinePlus

(A) Changes in glycated hemoglobin (HbA1c), (B) fasting plasma glucose (FPG), (C) 2-hour postprandial glucose (2h-PPG) values in all patients, (D) HbA1c in group 1 (HbA1c ≤7% at 12 weeks after switching), and (E) HbA1c in group 2 (HbA1c >7% at 12 weeks after switching) before and after switching from glimepiride to sitagliptin. Data are presented as the mean±SD. Paired t test. aP<0.05 vs. baseline.
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Figure 1: (A) Changes in glycated hemoglobin (HbA1c), (B) fasting plasma glucose (FPG), (C) 2-hour postprandial glucose (2h-PPG) values in all patients, (D) HbA1c in group 1 (HbA1c ≤7% at 12 weeks after switching), and (E) HbA1c in group 2 (HbA1c >7% at 12 weeks after switching) before and after switching from glimepiride to sitagliptin. Data are presented as the mean±SD. Paired t test. aP<0.05 vs. baseline.

Mentions: The HbA1c level was 7.4%±1.4% at 12 weeks after the switch from glimepiride to sitagliptin and tended to decrease (7.3%±1.2%) after 24 weeks (P=0.8, P=0.241, respectively). FPG was also comparable before and after switching drugs (134.1±36.0 mg/dL at baseline, 137.2±37.8 mg/dL at 12 weeks after switching, 135.0±32.1 mg/dL at 24 weeks after switching). However, the switch from glimepiride to sitagliptin significantly reduced the 2h-PPG level by 21 mg/dL (218.0±67.5 to 197.1±69.9 mg/dL, P=0.045) at week 12 and by 26 mg/dL (218±67 to 192.3±67.4 mg/dL, P=0.018) at week 24 (Fig. 1). The proportion of patients who reached the target HbA1c level of <7% was 31.1% at baseline, which increased to 44.3% and 42.6% at 12 and 24 weeks, respectively. All but one patient stopped experiencing hypoglycemia after discontinuing the sulfonylurea.


Optimal candidates for the switch from glimepiride to sitagliptin to reduce hypoglycemia in patients with type 2 diabetes mellitus.

Kim HM, Lim JS, Lee BW, Kang ES, Lee HC, Cha BS - Endocrinol Metab (Seoul) (2014)

(A) Changes in glycated hemoglobin (HbA1c), (B) fasting plasma glucose (FPG), (C) 2-hour postprandial glucose (2h-PPG) values in all patients, (D) HbA1c in group 1 (HbA1c ≤7% at 12 weeks after switching), and (E) HbA1c in group 2 (HbA1c >7% at 12 weeks after switching) before and after switching from glimepiride to sitagliptin. Data are presented as the mean±SD. Paired t test. aP<0.05 vs. baseline.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4384675&req=5

Figure 1: (A) Changes in glycated hemoglobin (HbA1c), (B) fasting plasma glucose (FPG), (C) 2-hour postprandial glucose (2h-PPG) values in all patients, (D) HbA1c in group 1 (HbA1c ≤7% at 12 weeks after switching), and (E) HbA1c in group 2 (HbA1c >7% at 12 weeks after switching) before and after switching from glimepiride to sitagliptin. Data are presented as the mean±SD. Paired t test. aP<0.05 vs. baseline.
Mentions: The HbA1c level was 7.4%±1.4% at 12 weeks after the switch from glimepiride to sitagliptin and tended to decrease (7.3%±1.2%) after 24 weeks (P=0.8, P=0.241, respectively). FPG was also comparable before and after switching drugs (134.1±36.0 mg/dL at baseline, 137.2±37.8 mg/dL at 12 weeks after switching, 135.0±32.1 mg/dL at 24 weeks after switching). However, the switch from glimepiride to sitagliptin significantly reduced the 2h-PPG level by 21 mg/dL (218.0±67.5 to 197.1±69.9 mg/dL, P=0.045) at week 12 and by 26 mg/dL (218±67 to 192.3±67.4 mg/dL, P=0.018) at week 24 (Fig. 1). The proportion of patients who reached the target HbA1c level of <7% was 31.1% at baseline, which increased to 44.3% and 42.6% at 12 and 24 weeks, respectively. All but one patient stopped experiencing hypoglycemia after discontinuing the sulfonylurea.

Bottom Line: We investigated the efficacy and safety of sitagliptin when patients switched from a sulfonylurea to sitagliptin and identified good candidates for the switch.Sixty-one patients with type 2 diabetes switched from glimepiride with metformin to sitagliptin with metformin due to clinical hypoglycemia.Patients with dominant insulin resistance may be good candidates for switching from a sulfonylurea to sitagliptin to reduce hypoglycemia.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Sitagliptin is a novel antidiabetic agent with a low risk for hypoglycemia. We investigated the efficacy and safety of sitagliptin when patients switched from a sulfonylurea to sitagliptin and identified good candidates for the switch.

Methods: Sixty-one patients with type 2 diabetes switched from glimepiride with metformin to sitagliptin with metformin due to clinical hypoglycemia. Serum glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2-hour postprandial plasma glucose (2h-PPG) before and 12 and 24 weeks after the drug switch were checked.

Results: HbA1c and FPG levels did not change 12 or 24 weeks after the switch; however, the 2h-PPG level decreased from 218.0±67.5 mg/dL at baseline to 197.1±69.9 mg/dL at 12 weeks and 192.3±67.4 mg/dL at 24 weeks after switching drugs (P=0.045, P=0.018, respectively). All but one patient no longer experienced hypoglycemia after discontinuing glimepiride. In a multivariate logistic regression analysis, a high homeostasis model assessment of insulin resistance and low baseline HbA1c level were independent predictors of an HbA1c ≤7% after switching to sitagliptin.

Conclusion: Glycemic control was not aggravated in patients 24 weeks after the drug switch, and symptomatic hypoglycemia decreased significantly. Patients with dominant insulin resistance may be good candidates for switching from a sulfonylurea to sitagliptin to reduce hypoglycemia.

No MeSH data available.


Related in: MedlinePlus