Effect of sitagliptin on glucose control in type 2 diabetes mellitus after Roux‐en‐Y gastric bypass surgery

Abstract

The present study was a 4-week randomized trial to assess the efficacy and safety of sitagliptin, a dipeptidyl-peptidase-4 inhibitor, in persistent or recurring type 2 diabetes after Roux-en-Y gastric bypass surgery (RYGB). Participants (n = 32) completed a mixed meal test (MMT) and self-monitoring of plasma glucose (SMPG) before and 4 weeks after randomization to either sitagliptin 100 mg daily or placebo daily. Questionnaires were administered to assess gastrointestinal discomfort. Outcome variables were glucose, active glucagon-like peptide-1 and β-cell function during the MMT, and glucose levels during SMPG. Age (56.3 ± 8.2 years), body mass index (34.4 ± 6.7 kg/m2), glycated haemoglobin (7.21 ± 0.77%), diabetes duration (12.9 ± 10.0 years), years since RYGB (5.6 ± 3.3 years) and β-cell function did not differ between the placebo and sitagliptin groups at pre-intervention. Sitagliptin was well tolerated, decreased postprandial glucose levels during the MMT (from 8.31 ± 1.92 mmol/L to 7.67 ± 1.59 mmol/L, P = 0.03) and mean SMPG levels, but had no effect on β-cell function. In patients with diabetes and mild hyperglycemia after RYGB, a short course of sitagliptin provided a small but significant glucose-lowering effect, with no identified improvement in β-cell function.

Adjunctive liraglutide treatment in patients with persistent or recurrent type 2 diabetes after metabolic surgery (GRAVITAS): a randomised, double-blind, placebo-controlled trial

“…Patients on DPP-4 inhibitors were excluded as these could interact with Liraglutide. There is only one placebo-controlled RCT to our knowledge that examined the effect of a 4 week course of Sitagliptin after RYGB which demonstrated significantly decreased postprandial glucose levels during a mixed meal tolerance test 25 . The CARAT placebo-controlled RCT was also planned to examine the effect on Canagliflozin in post metabolic surgery patients with persistent T2DM 26 but this trial appears to have been terminated without results (ClinicalTrials.Org NCT02912455).…”

Double‐blinded, randomized, and controlled study on the effects of canagliflozin after bariatric surgery: A pilot study

“…The present study observed significant reductions in blood glucose (−32.90 mg/dL) after 6 months. In a similar population, another randomized controlled study observed modest reductions in blood glucose (−12 mg/dL) by comparison; in that study, patients were randomized to receive placebo or sitagliptin (100 mg) for 4 weeks . If study duration was longer in the trial that investigated sitagliptin, the reductions in blood glucose may have been more marked.…”

“…Therefore, clinical judgment is exercised when deciding which agent to prescribe. Some studies have been retrospective in nature and, for example, investigated the effects of liraglutide on weight loss outcomes; while one study noted the effects of sitagliptin after bariatric surgery, additional insight is needed …”

Proinsulin associates with poor β‐cell function, glucose‐dependent insulinotropic peptide, and insulin resistance in persistent type 2 diabetes after Roux‐en‐Y gastric bypass in humans

“…Individuals from Cohort 2 were recruited for a separate randomized control trial on the effect of a dipeptidyl peptidase (DPP)-4 inhibitor on glucose control in T2D after RYGB. 15 Recruitment for Cohort 2, described previously, 15 was done from 2012 to 2016 as follows: (1) screening of medical records and mass mailing to patients with documented T2D, HbA1c > 7% and/or on insulin treatment prior to RYGB who underwent RYGB at St. Luke’s Roosevelt Hospital at least 1 year prior to 2012 (n = 117); or (2) by direct referrals from healthcare providers (n = 7). Interested patients (60 of 124) were then invited for a screening visit and, if the diagnosis of T2D was confirmed, were enrolled after proper consenting (n = 32).…”