Effect of sitagliptin on glucose control in adult patients with Type 1 diabetes: a pilot, double‐blind, randomized, crossover trial
Diabet. Med. 28, 1176–1181 (2011)
Aims Patients with Type 1 diabetes have significantly elevated postprandial glucagon secretion. Dipeptidyl peptidase IV inhibitors improve HbA1c by several mechanisms, including increasing glucagon‐like peptide 1 and glucose‐dependent insulinotropic peptide concentrations, which decreases postprandial rises in glucagon in both Type 1 and Type 2 diabetes. This study evaluates the clinical implications of sitagliptin in adult patients with Type 1 diabetes.
Methods This investigator‐initiated, double‐blind, randomized, crossover, 8‐week, pilot study enrolled 20 adult subjects with Type 1 diabetes. Subjects received sitagliptin 100 mg/day or placebo for 4 weeks and then crossed over. Outcomes included 2‐h postprandial blood glucose and 24‐h area under the curve changes in glucose measurements from continuous glucose monitoring, HbA1c, fructosamine and insulin dose.
Results Sitagliptin significantly reduced blood glucose (2‐h postprandial and 24‐h area under the curve) despite reduced total and prandial insulin dose. Based on continuous glucose monitor findings, sitagliptin improved measures of glycaemic control, including mean blood glucose (−0.6 mmol/l; P = 0.012) and time in euglycaemic range 4.4–7.8 mmol/l (0.4 ± 0.2 h; P = 0.046). Significant reductions were also observed in M100, Glycemic Risk Assessment Diabetes Equation (GRADE) and J‐index. After controlling for period, treatment and insulin dose, the HbA1c was also significantly reduced [−0.27 ± 0.11% (−2.91 ± 1.16 mmol/mol); P = 0.025] when patients were taking sitagliptin.
Conclusions Sitagliptin significantly improved overall glucose control, including postprandial and 24‐h glucose control, in adult patients with Type 1 diabetes, while significantly reducing prandial insulin requirements. Further investigation is warranted in patients with Type 1 diabetes in a larger cohort designed to assess both clinical outcomes and mechanism of action.
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Document Type: Research Article
Affiliations: Barbara Davis Center for Childhood Diabetes
Publication date: 01 October 2011