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The Effectiveness of Combination Treatment with Insulin and Sitagliptin in T2 Patients

Patients on therapy may see increased reduction in HbA1c, lower BP, lower lipid values….

 

Dipeptidyl peptidase-4 (DPP-4) inhibitors are used for the treatment of type 2 diabetes. Sitagliptin was the first medication approved for people with type 2 diabetes who are taking insulin. There are not a lot of studies that have investigated the use of DPP-4 and insulin therapy in patients with long-term diabetes diagnosis. Currently, there aren’t any studies that have evaluated the efficiency of DPP-4 inhibitors in activating insulin feedback in patients with minimal insulin secretion who are on insulin therapy.

Researchers evaluated the effectiveness and safety of insulin-sitagliptin combination treatment to establish the benefit of this regimen in patients with type 2 diabetes. The study design was a multicenter retrospective study from November 2011 to March 2013. The study was conducted in 36 diabetes clinic in Kanagawa Prefecture, Japan. Patients who were eligible were on insulin 6 months prior and on sitagliptin if their HbA1c was 7.0% or higher with insulin therapy. The primary endpoint was the variation in HbA1c levels. The results from this study were reported as mean + standard deviation. Other endpoints in this study were weight, blood pressure values, total cholesterol, and triglycerides.

The study included 1,169 patients. The results showed that most patients (n=809) received sitagliptin 50mg. In 1,004 patients, HbA1c was reduced by 0.74% and body weight was increased by 0.1kg after 6 months of combination treatment of insulin and sitagliptin. In this study, hypoglycemic events occurred in 7.4% of the patient population, however none of the events were severe. Also, a multiple regression analysis on 114 patients showed that C-peptide had no effect on the effectiveness of sitagliptin. These patients had C-peptide data before initiation of sitagliptin therapy. The result showed that the combination in therapy caused a decrease in systolic blood pressure, total cholesterol, and triglycerides.

The researchers concluded that sitagliptin and insulin combination therapy decreased HbA1c in a real-world setting.

Practice Pearls:

  • Insulin and sitagliptin therapy is safe and effective in patients with type 2 diabetes.
  • Patients taking a combination of insulin and sitagliptin therapy may experience increased reduction in HbA1c values.
  • The combination of insulin and sitagliptin treatment can potentially lower blood pressure and lipid values.

Ishikawa M, Takai M, Maeda H, et al. “Factors Predicting Therapeutic Efficacy of Combination Treatment With Sitagliptin and Insulin in Type 2 Diabetic Patients: The ASSIST-K Study.” J Clin Med Res. 2015;7(8):607-12.