Effect of short‐term treatment with sitagliptin or glibenclamide on daily glucose fluctuation in drug‐naïve Japanese patients with type 2 diabetes mellitus

Abstract

This study suggests that the DPP4 inhibitor sitagliptin has a greater ability to reduce daily glucose fluctuation than the SU glibenclamide in drug-naïve Japanese patients with T2DM. ClinicalTrials.gov: NCT02318693.

Effects of DPP-4 Inhibitors on Blood Glucose Variability in Japanese Patients with Type 2 Diabetes on Maintenance Hemodialysis: A Prospective Observational Exploratory Study

“…The ability of DPP-4 inhibitors to suppress BG variability in patients with type 2 diabetes has been shown in studies using CGM [51, 52]. Furthermore, several RCTs using CGM found that BG variability is suppressed more effectively by DPP-4 inhibitors than by other agents such as sulfonylureas [41,42] and sodium glucose cotransporter 2 inhibitors [43][44][45] [41,49], or had used metformin only [41][42][43]46]. There have also been some reports on the usefulness of DPP-4 inhibitors in patients on hemodialysis [50], but none has shown obvious suppression of BG variability.…”

“…Also, our data from the linear mixed-effects model showed a rapid BG drop during hemodialysis and a tendency for hypoglycemia in the subsequent nighttime period in maintenance hemodialysis patients with type 2 diabetes. Although DPP-4 inhibitors have been shown to improve BG variability in patients with type 2 diabetes in many randomized controlled trials (RCTs) [ 41 – 49 ] (see the table in the Electronic supplementary material), few studies have reported the same effect in maintenance hemodialysis patients [ 50 ]. Our study illustrates the usefulness of DPP-4 inhibitors in these patients.…”

“…The ability of DPP-4 inhibitors to suppress BG variability in patients with type 2 diabetes has been shown in studies using CGM [ 51 , 52 ]. Furthermore, several RCTs using CGM found that BG variability is suppressed more effectively by DPP-4 inhibitors than by other agents such as sulfonylureas [ 41 , 42 ] and sodium glucose cotransporter 2 inhibitors [ 43 – 45 ] or by combination with insulin therapy [ 46 – 49 ]. The patients in these RCTs who showed suppressed BG variability with DPP-4 inhibitors had a mean age of less than 60 years [ 42 – 44 , 46 , 48 , 49 ], had HbA1c > 7% [ 41 – 44 , 46 – 49 ], were drug naïve [ 41 , 49 ], or had used metformin only [ 41 – 43 , 46 ].…”

“…The reduction in prandial glucagon is believed to be the most important mechanism through which DPP-4 inhibitors improve the BG wave [ 35 ]. The present study showed that DPP-4 inhibitors are as effective in dialysis patients as in type 2 diabetes patients not undergoing hemodialysis [ 41 , 44 , 48 ]. The mechanisms are unclear, and more detailed studies are needed, including those that analyze the fluctuation in glucagon.…”

Effect of DPP-IV Inhibitors on Glycemic Variability in Patients with T2DM: A Systematic Review and Meta-Analysis

“…Characteristics of the seven studies 9,10,13–17 included in the analyses are shown in Table 1. The total number of included patients was 304, and all were Asian T2DM patients.…”