Secretion of glucagon- like peptide-1 (GLP-1) in type 2 diabetic patients: Study of its relation to glucose lowering effect of dipeptidyl peptidase IV (DPP-IV) inhibitors. (original) (raw)
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AIMS/INTRODUCTION: Eicosapentaenoic acid (EPA) stimulates glucagon-like peptide-1 (GLP-1) secretion in mice. We investigated the relationship between serum EPA concentrations and the efficacy of dipeptidyl-peptidase IV (DPP-4) inhibitor in patients with type 2 diabetes. MATERIALS AND METHODS: Serum EPA concentrations were measured in 62 consecutive patients with type 2 diabetes who were newly given DPP-4 inhibitor as a monotherapy or as an add-on therapy to oral hypoglycemic agents. The dosage of oral hypoglycemic agents was maintained during the observation period. After 24 weeks of treatment with DPP-4 inhibitor, we evaluated the relationships between a decrease in hemoglobin A1c from baseline and serum EPA concentrations, as well as age, sex, body mass index (BMI), hemoglobin A1c at baseline and usage of antidiabetic concomitant drugs. RESULTS: Hemoglobin A1c was significantly decreased from 8.1 ± 1.1% to 7.2 ± 1.0% by DPP-4 inhibitor. A decrease in hemoglobin A1c correlated with BMI (r = -0.396, P = 0.0013), age (r = 0.275, P = 0.0032), hemoglobin A1c at baseline (r = 0.490, P < 0.0001) and log EPA (r = 0.285, P = 0.0246). Multiple regression analysis showed that BMI (β = -0.419, P = 0.0002), hemoglobin A1c at baseline (β = 0.579, P < 0.0001) and log EPA (β = 0.220, P = 0.0228) were independent determinants of decrease in hemoglobin A1c. CONCLUSIONS: DPP-4 inhibitor is effective in patients with type 2 diabetes with high serum EPA concentrations.
Journal of Diabetes Investigation, 2012
Aims/Introduction: Recently, dipeptidyl peptidase-4 (DPP-4) inhibitors have become available in Japan. It has not yet been clarified what clinical parameters could discriminate DPP-4 inhibitor-effective patients from DPP-4 inhibitor-ineffective patients. Materials and Methods: We reviewed 33 consecutive patients with type 2 diabetes admitted to Osaka University Hospital for glycemic control. All of the patients were treated with medical nutrition therapy plus insulin therapy to improve fasting plasma glucose (FPG) and postprandial glucose below 150 and 200 mg/dL, respectively. After insulin secretion and insulin resistance were evaluated, insulin was replaced by DPP-4 inhibitors. The efficacy of DPP-4 inhibitors was determined according to whether glycemic control was maintained at the target levels. Results: Dipeptidyl peptidase-4 inhibitors were effective in 16 of 33 patients. DPP-4 inhibitor-effective patients were younger than DPP-4 inhibitor-ineffective patients. Body mass index (BMI) was significantly higher in DPP-4 inhibitor-effective patients. Endogeneous insulin-secreting capacity, including insulinogenic index (II), fasting plasma C-peptide (F-CPR) and C-peptide index (CPI), was more sustained in DPP-4 inhibitor-effective patients than DPP-4 inhibitor-ineffective patients. Insulin resistance evaluated by homeostasis model assessment of insulin resistance (HOMA-IR) was significantly higher in DPP-4 inhibitor-effective patients than DPP-4 inhibitor-ineffective patients. In receiver operating characteristic analyses, the cutoff values for predicting the efficacy of DPP-4 inhibitors were 0.07 for II, 1.5 ng/mL for F-CPR, 1.0 for CPI, 23.0 kg/m 2 for BMI, 1.3 for HOMA-IR and 67.5 years for age. Conclusions: Dipeptidyl peptidase-4 inhibitors were effective in Japanese type 2 diabetic patients with sustained endogenous insulin-secreting capacity, a higher BMI and insulin resistance. (J Diabetes Invest
A Comparative Study on Management of Diabetes Mellitus Relation to Dipeptidyl Peptidase-4 Inhibitors
Background: The incidence of Diabetes Mellitus has increased dramatically in recent decades. Di Peptidyl Peptidase 4 inhibitors (DPP-4) have their role in glycemic control. An impaired 'incretin effect', occurs in patients with type 2 Diabetes Mellitus in response to glucose intake. Objectives: The main objective of the study is to compare therapeutic outcomes and adverse drug reactions among commonly prescribed anti diabetic drug combinations in adults with type 2 diabetes mellitus. Methodology: A retrospective and prospective study experimental study was carried out for a period of one year at care diabetes centre, Warangal, Telangana. Results: FBS and PLBS were found to be significantly lower in DPP group when compared with SU and TZ. Adverse events such as itching, abdominal pain, constipation and weight loss are more in DPP when compared with other groups. Data from this study indicated thatDPP-4 inhibitors are superior to sulfonylureas (SU) and thiazolidinediones (TZ) when used in combination with metformin (B) in glycemic control. Conclusion: DPP inhibitors provide an effective therapeutic option for individuals with Type 2 Diabetes along with obesity.
Journal of Postgraduate Medical Institute, 2011
The burden of diabetic patients on healthcare has increased over the period of time. Management of diabetes presents a challenge to the physician. The availability of newer drugs, tested in high quality clinical trials, has marked a new era in the treatment of diabetes. Glucagon-like peptide 1 (GLP-1) analogs act by increasing the pancreatic beta-cell mass and subsequent insulin secretion. Dipeptidase-4 (DPP-4) inhibitors inhibit the enzyme that degrades GLP-1, resulting in the augmentation of GLP-1 in the body. Hence, the two drugs can be used synergistically. It was seen that severe hypoglycemia seldom occurred with GLP-1 analogues and DPP-4 inhibitors. Gastrointestinal upset and the development of antibodies to the drug in the body was mainly attributed to GLP-1 analogs. DPP-4 inhibitors showed increased risk of nasopharyngitis, urinary tract infections and headache. There is a need for further advances in our understanding, through randomized control clinical trials in larger se...
This study was initiated to identify clinical and dietary parameters that predict efficacy of dipeptidyl peptidase-4 inhibitors. A total of 72 untreated Japanese patients with type 2 diabetes who received DPP-4 inhibitors (sitagliptin, alogliptin or vildagliptin) for 4 months were examined for changes of glycated hemoglobin (HbA 1c ) and body mass index (BMI), and self-administered 3-day food records, as well as serum levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). DPP-4 inhibitors significantly reduced HbA 1c (before initiation of DPP-4 inhibitors 7.2 ± 0.7%, 4 months after initiation of DPP-4 inhibitors 6.7 ± 0.6% [paired t-test, P < 0.01 vs before]). Multiple regression analysis showed that changes of HbA 1c were significantly correlated with baseline HbA 1c, as well as estimated intake of fish. Furthermore, changes of HbA 1c were significantly correlated with serum levels of EPA (r = )0.624, P < 0.01) and DHA (r = )0.577, P < 0.01). HbA 1c reduction by DPP-4 inhibitors is significantly correlated with estimated intake of fish and serum levels of EPA and DHA. (J Diabetes Invest,
Context: clinical outcomes of Dipeptidyl Peptidase-4 inhibitors can be beneficial for the patients in controlling high blood sugar it can also cause potential adverse effects Aim: The main objective of this study was to assess the risks and benefits of Dipeptidyl peptidase-4inhibitors (DPP-4I) in type 2 diabetes mellitus patients. Method: systematical articles on Dipeptidyl peptidase-4 inhibitors were reviewed from the year 2015 up to 2017 from 3 databases such as: EMBASE, COCHRANE and MEDSCAPE and some diabetes associations, the main such were: DPP-4 inhibitor, incretin, type 2 diabetes mellitus, Vildagliptin, Sitagliptin, Linagliptin, Saxagliptin, Alogliptin, 69 citations were included after screening for duplication and biased articles. Results: All DPP-4I are efficacious for improving blood glucose level among type 2 diabetes mellitus patients without causing hypoglycemic effects, and they can be used as monotherapy or in combination with other antidiabetic agents, Linagliptin offer uniqueness properties due to its non-renal excretion it improves microalbuminuria, whereas remaining DDP-4I cause a marginal changes on renal function, there is no hepatotoxicity among the DPP-4I no dose adjustment for Linagliptin, Sitagliptin, saxagliptin due non-hepatic excretion, only dose reduction is required for patients with minor hepatic functional impairment taking Vildagliptin and saxagliptin due to their partially elimination via liver,DPP-4I also protect patients for cardiovascular complications due its ability of reducing or maintaining the stability of body weight and lipid profile. They also show a low risk for increasing pancreatitis among T2DM and the others side effect were comparable less when compared to other anti-hyperglycemic agents. Conclusion: DPP-4I significantly control blood sugar level by decreasing glycated hemoglobin, fasting blood sugar, random blood sugar and they are not associated with hypoglycemic events they also minimize cardiovascular complications by reducing fats and weight in type 2 diabetes mellitus patients, in addition DPP-4I helps in renal and liver protection. Over all, DPP-4I reduce morbidity and mortality rate among T2DM patients.
Background: Diabetes is a chronic metabolic disease which affects the quality of life. It leads to multiple complications due to metabolic involvement. Out of multiple drugs used to treat diabetes, dipeptidyl peptidase 4 (DPP-4) inhibitors are comparatively new drugs used for type-2-diabetes mellitus (DM) treatment. This study aimed to find out the drug utilization (DU) 90% and use of DPP-4 inhibitors in patients with type-2-DM. Methods: A prospective, cross-sectional, observational study was conducted at a private healthcare clinic of an endocrinologist in Nashik. Type-2-DM patients of both sexes were selected and a total of 199 patients were enrolled in the study. The consented patients were interviewed and prescription copies were collected. After studying them; statistical analysis was done and results and conclusions were drawn. Results: Out of total prescribed drugs, 58.77% of drugs were anti-diabetics. It was observed that the biguanides were most frequently (25.32%) prescribed while the least prescribed drugs were meglitinide analogues (0.08%). Most commonly utilized anti-diabetic found to be metformin. Vildagliptin 50 mg is the most commonly prescribed drug from DPP-4 inhibitors. Most of the drugs from the DPP-4 inhibitor group came under DU90%. Conclusions: DPP-4 inhibitors are showing wide acceptability by endocrinologists for type-2-DM management, according to this study. Performing repetitive drug utilization pattern study and circulation of standard treatment guidelines to practising physicians can be required. To emphasize the point on generic prescription, more awareness should be created. So that these can responses to further cost-effective and rational prescribing practices.