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Factors Predicting Therapeutic Efficacy of Combination Treatment With Sitagliptin and Insulin in Type 2 Diabetic Patients: The ASSIST-K Study.

Ishikawa M, Takai M, Maeda H, Kanamori A, Kubota A, Amemiya H, Iizuka T, Iemitsu K, Iwasaki T, Uehara G, Umezawa S, Obana M, Kaneshige H, Kaneshiro M, Kawata T, Sasai N, Saito T, Takuma T, Takeda H, Tanaka K, Tsurui N, Nakajima S, Hoshino K, Honda S, Machimura H, Matoba K, Minagawa F, Minami N, Miyairi Y, Mokubo A, Motomiya T, Waseda M, Miyakawa M, Naka Y, Terauchi Y, Tanaka Y, Matsuba I - J Clin Med Res (2015)

Bottom Line: Hypoglycemic symptoms occurred in 7.4%, but none were severe.Glucose-dependent suppression of glucagon secretion by sitagliptin may be useful in patients with impaired insulin secretion.Sitagliptin can be used concomitantly with insulin irrespective of the insulin regimen, duration of insulin treatment, and concomitant medications.

View Article: PubMed Central - PubMed

Affiliation: The Study Group of the Diabetes Committee, Kanagawa Physicians Association, 3-1 Fujimi-cho, Naka-ku, Yokoyama City, Kanagawa 231-0037, Japan.

ABSTRACT

Background: It is unclear whether dipeptidyl peptidase-4 inhibitors decrease hemoglobin A1c (HbA1c) in a glucose-dependent manner in patients on insulin therapy who have impaired insulin secretion. This study investigated factors influencing the efficacy of sitagliptin when used concomitantly with insulin to treat type 2 diabetes mellitus (T2DM) in the real-world setting.

Methods: A retrospective study was conducted of 1,004 T2DM patients at 36 Japanese clinics associated with the Diabetes Task Force of the Kanagawa Physicians Association. Eligible patients had been on insulin for at least 6 months, with a baseline HbA1c of 7.0% (53 mmol/mol) or higher. Baseline characteristics and laboratory data from 495 patients were subjected to multiple regression analysis to identify factors influencing the change of HbA1c.

Results: Most patients (n = 809) received sitagliptin at a dose of 50 mg. In the 1,004 patients, HbA1c decreased by 0.74% (6 mmol/mol) and body weight increased by 0.1 kg after 6 months of combination therapy. Multiple regression analysis showed that a higher baseline HbA1c, older age, and lower body mass index influenced the change of HbA1c after 6 months. Hypoglycemic symptoms occurred in 7.4%, but none were severe.

Conclusions: These results emphasize the importance of a higher HbA1c at the commencement of sitagliptin therapy in patients on insulin. Glucose-dependent suppression of glucagon secretion by sitagliptin may be useful in patients with impaired insulin secretion. Sitagliptin can be used concomitantly with insulin irrespective of the insulin regimen, duration of insulin treatment, and concomitant medications.

No MeSH data available.


Related in: MedlinePlus

Changes in hemoglobin A1c, body weight, and insulin dose (n = 1,004). Data are the mean ± standard deviation. Analysis of variance vs. baseline. *P < 0.05. M: months.
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Figure 1: Changes in hemoglobin A1c, body weight, and insulin dose (n = 1,004). Data are the mean ± standard deviation. Analysis of variance vs. baseline. *P < 0.05. M: months.

Mentions: After starting insulin-sitagliptin combination therapy, HbA1c decreased significantly from the baseline value of 8.69±1.31% (72 ± 12 mmol/mol) to 8.30±1.23% (67 ± 11 mmol/mol), 7.99±1.25% (64 ± 11 mmol/mol), and 7.95±1.25% (64 ± 11 mmol/mol) at 1 month, 3 months, and 6 months, respectively. Body weight showed a slight, but significant, increase of 0.1 kg, while there were no changes in the doses of insulin or the other oral antidiabetic drugs (Fig. 1).


Factors Predicting Therapeutic Efficacy of Combination Treatment With Sitagliptin and Insulin in Type 2 Diabetic Patients: The ASSIST-K Study.

Ishikawa M, Takai M, Maeda H, Kanamori A, Kubota A, Amemiya H, Iizuka T, Iemitsu K, Iwasaki T, Uehara G, Umezawa S, Obana M, Kaneshige H, Kaneshiro M, Kawata T, Sasai N, Saito T, Takuma T, Takeda H, Tanaka K, Tsurui N, Nakajima S, Hoshino K, Honda S, Machimura H, Matoba K, Minagawa F, Minami N, Miyairi Y, Mokubo A, Motomiya T, Waseda M, Miyakawa M, Naka Y, Terauchi Y, Tanaka Y, Matsuba I - J Clin Med Res (2015)

Changes in hemoglobin A1c, body weight, and insulin dose (n = 1,004). Data are the mean ± standard deviation. Analysis of variance vs. baseline. *P < 0.05. M: months.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4471747&req=5

Figure 1: Changes in hemoglobin A1c, body weight, and insulin dose (n = 1,004). Data are the mean ± standard deviation. Analysis of variance vs. baseline. *P < 0.05. M: months.
Mentions: After starting insulin-sitagliptin combination therapy, HbA1c decreased significantly from the baseline value of 8.69±1.31% (72 ± 12 mmol/mol) to 8.30±1.23% (67 ± 11 mmol/mol), 7.99±1.25% (64 ± 11 mmol/mol), and 7.95±1.25% (64 ± 11 mmol/mol) at 1 month, 3 months, and 6 months, respectively. Body weight showed a slight, but significant, increase of 0.1 kg, while there were no changes in the doses of insulin or the other oral antidiabetic drugs (Fig. 1).

Bottom Line: Hypoglycemic symptoms occurred in 7.4%, but none were severe.Glucose-dependent suppression of glucagon secretion by sitagliptin may be useful in patients with impaired insulin secretion.Sitagliptin can be used concomitantly with insulin irrespective of the insulin regimen, duration of insulin treatment, and concomitant medications.

View Article: PubMed Central - PubMed

Affiliation: The Study Group of the Diabetes Committee, Kanagawa Physicians Association, 3-1 Fujimi-cho, Naka-ku, Yokoyama City, Kanagawa 231-0037, Japan.

ABSTRACT

Background: It is unclear whether dipeptidyl peptidase-4 inhibitors decrease hemoglobin A1c (HbA1c) in a glucose-dependent manner in patients on insulin therapy who have impaired insulin secretion. This study investigated factors influencing the efficacy of sitagliptin when used concomitantly with insulin to treat type 2 diabetes mellitus (T2DM) in the real-world setting.

Methods: A retrospective study was conducted of 1,004 T2DM patients at 36 Japanese clinics associated with the Diabetes Task Force of the Kanagawa Physicians Association. Eligible patients had been on insulin for at least 6 months, with a baseline HbA1c of 7.0% (53 mmol/mol) or higher. Baseline characteristics and laboratory data from 495 patients were subjected to multiple regression analysis to identify factors influencing the change of HbA1c.

Results: Most patients (n = 809) received sitagliptin at a dose of 50 mg. In the 1,004 patients, HbA1c decreased by 0.74% (6 mmol/mol) and body weight increased by 0.1 kg after 6 months of combination therapy. Multiple regression analysis showed that a higher baseline HbA1c, older age, and lower body mass index influenced the change of HbA1c after 6 months. Hypoglycemic symptoms occurred in 7.4%, but none were severe.

Conclusions: These results emphasize the importance of a higher HbA1c at the commencement of sitagliptin therapy in patients on insulin. Glucose-dependent suppression of glucagon secretion by sitagliptin may be useful in patients with impaired insulin secretion. Sitagliptin can be used concomitantly with insulin irrespective of the insulin regimen, duration of insulin treatment, and concomitant medications.

No MeSH data available.


Related in: MedlinePlus