Authors: Ellis, S. L.; Moser, E. G.; Snell-Bergeon, J. K.; Rodionova, A. S.; Hazenfield, R. M.; Garg, S. K.

Source: Diabetic Medicine, Volume 28, Number 10, 1 October 2011 , pp. 1176-1181(6)

Publisher: Wiley-Blackwell

Abstract:

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Diabet. Med. 28, 1176-1181 (2011) </section> <section xml:id="abs1-1"> <title type="main">Abstract</title>

Aims  Patients with Type 1 diabetes have significantly elevated postprandial glucagon secretion. Dipeptidyl peptidase IV inhibitors improve HbA_1c 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, HbA_1c, 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 HbA_1c 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. </section>

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1464-5491.2011.03331.x

Affiliations: 1: Barbara Davis Center for Childhood Diabetes

Publication date: 2011-10-01

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