Sitagliptin has been proven to be effective and safe as add-on to insulin in adult patients with type 2 diabetes and absolute insulin deficiency. Recently, it has been suggested to extend the use of dipeptidyl-peptidase-4 inhibitors also to type 1 diabetes. Aim of the study was to evaluate and compare the effects of long-term fixed-dose combination of sitagliptin and metformin as add-on to insulin on body mass, fasting plasma glucose (FPG), fructosamine, HbA1c, lipids and daily dose of insulin in both type 1 diabetes and insulin-treated type 2 diabetes. Were recruited 25 patients with type 1 diabetes (age 51±10 years, disease duration 26±13 years) and 31 insulin-treated type 2 diabetic patients (66±8 years, 19±9 years), who received sitagliptin with metformin fixed-dose combination (50/1000 mg once or twice daily) or sitagliptin (100 mg once daily, if intolerant to metformin) in addition to the on going insulin therapy for 46±19 weeks and 56±14 weeks, respectively. After 21±9 weeks, patients with type 1 diabetes had significantly lower BMI, FPG, fructosamine, HbA1c, and daily insulin requirement. After 49±17 weeks, they maintained the weight loss and total daily insulin dosage, showed a significant reduction in LDL cholesterol levels, whereas their HbA1c had returned to baseline values. In patients with type 2 diabetes, long-term treatment remained weight neutral but had persistent beneficial effects on short-, intermediate-, and long-term biomarkers of metabolic control, as well as on LDL cholesterol levels and insulin requirement. In conclusion, clinical outcomes differed by diabetes type in terms of quality and over time. In type 2 diabetes, the combination therapy improved significantly metabolic control and lipid profile as well as decreased insulin requirements even in the absence of clinically significant weight loss. In type 1 diabetes, the combined therapy improved only temporarily metabolic control, but decreased significantly body weight, LDL cholesterol levels, and insulin requirements.
Sitagliptin as add on therapy in insulin deficiency biomarkers of therapeutic efficacy respond differently in type 1 and type 2 diabetes
GIAMPIETRO, OTTAVIO;MATTEUCCI, ELENA
2013-01-01
Abstract
Sitagliptin has been proven to be effective and safe as add-on to insulin in adult patients with type 2 diabetes and absolute insulin deficiency. Recently, it has been suggested to extend the use of dipeptidyl-peptidase-4 inhibitors also to type 1 diabetes. Aim of the study was to evaluate and compare the effects of long-term fixed-dose combination of sitagliptin and metformin as add-on to insulin on body mass, fasting plasma glucose (FPG), fructosamine, HbA1c, lipids and daily dose of insulin in both type 1 diabetes and insulin-treated type 2 diabetes. Were recruited 25 patients with type 1 diabetes (age 51±10 years, disease duration 26±13 years) and 31 insulin-treated type 2 diabetic patients (66±8 years, 19±9 years), who received sitagliptin with metformin fixed-dose combination (50/1000 mg once or twice daily) or sitagliptin (100 mg once daily, if intolerant to metformin) in addition to the on going insulin therapy for 46±19 weeks and 56±14 weeks, respectively. After 21±9 weeks, patients with type 1 diabetes had significantly lower BMI, FPG, fructosamine, HbA1c, and daily insulin requirement. After 49±17 weeks, they maintained the weight loss and total daily insulin dosage, showed a significant reduction in LDL cholesterol levels, whereas their HbA1c had returned to baseline values. In patients with type 2 diabetes, long-term treatment remained weight neutral but had persistent beneficial effects on short-, intermediate-, and long-term biomarkers of metabolic control, as well as on LDL cholesterol levels and insulin requirement. In conclusion, clinical outcomes differed by diabetes type in terms of quality and over time. In type 2 diabetes, the combination therapy improved significantly metabolic control and lipid profile as well as decreased insulin requirements even in the absence of clinically significant weight loss. In type 1 diabetes, the combined therapy improved only temporarily metabolic control, but decreased significantly body weight, LDL cholesterol levels, and insulin requirements.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
