Obesity may attenuate the HbA1c‐lowering effect of sitagliptin in Japanese type 2 diabetic patients

Abstract

Aims/Introduction: The aim of the present study was to assess the independent predictors of the HbA1c‐lowering effect of sitagliptin in Japanese type 2 diabetic patients.Materials and Methods: Data were retrieved from the medical records of 151 type 2 diabetic patients who had been taking sitagliptin 25 or 50 mg once daily for inadequate glycemic control for at least 12 weeks, with or without other oral hypoglycemic agents. Spearman’s rank correlation coefficients were calculated to investigate correlations between two independent continuous variables. Multiple stepwise regression analysis was used to identify independent predictors of reductions in HbA1c levels after 12 weeks of sitagliptin treatment (ΔHbA1c).Results: In all patients combined, Spearman’s rank correlation coefficients showed that ΔHbA1c was significantly correlated with baseline HbA1c alone (r = 0.371, P < 0.0001). However, multiple linear regression analysis among all patients using baseline variables revealed that the independent factors contributing to ΔHbA1c, in order of importance, were method of prescribing (P < 0.0001), baseline HbA1c (P < 0.0001), body mass index (BMI; P = 0.004), and duration of diabetes (P = 0.024).Conclusions: Our analysis may provide novel evidence that increased BMI contributes, in part, to attenuation of the HbA1c‐lowering effect of sitagliptin in Japanese type 2 diabetic patients. Analysis of a larger population over a longer period of time is warranted to confirm these findings. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00156.x, 2011)

Evaluation of the Effects of Exenatide Administration in Patients with Type 2 Diabetes with Worsened Glycemic Control Caused by Glucocorticoid Therapy

“…We recently reported that another GLP-1 analogue, liraglutide, is more effective in earlier stages of diabetes (30). Similarly, sitagliptin, the first oral DPP-4 inhibitor, is more effective in patients with a shorter duration of diabetes (31). Likewise, in patients whose glycemic control is worsened by GC therapy, it is plausible to consider that earlier intervention with exenatide is more effective as well as other incretin-related drugs.…”

Pharmacological reduction of NEFA restores the efficacy of incretin-based therapies through GLP-1 receptor signalling in the beta cell in mouse models of diabetes

“…It has also been reported that loss of the incretin effects was more extensive in obese than in lean type 2 diabetic patients [25]. More recently, Bando et al reported that obesity may attenuate the HbA 1c -lowering effect of sitagliptin in Japanese type 2 diabetic patients [26]. This suggests that lipids may be involved in the regulation of incretin responsiveness in pancreatic beta cells.…”

The Glucose-lowering Efficacy of Sitagliptin in Obese Japanese Patients with Type 2 Diabetes

“…In previous reports involving larger cohorts than the present study, or in which most of the participants had BMI values of 22 to <30 kg/m 2 , the baseline BMI was related to the HbA1c-lowering effect of sitagliptin (8-10). Thus, in the present study the power of detection might have been somewhat weak.…”

“…However, some Japanese retrospective studies have shown a negative correlation between the glucose-lowering efficacy of sitagliptin (a DPP-4 inhibitor) and the baseline body mass index (BMI) value (8-10). On the other hand, other studies found no relationship between the glucose-lowering efficacy of DPP-4 inhibitors and the BMI (11,12).…”