Sitagliptin Add-on to Metformin Therapy: The Efficacy of Dual Therapy on Glycemic Control in Type 2 Diabetes

Abstract

Objectives: Sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, is an effective and well tolerated incretin-based therapy when used in addition to metformin therapy. We aimed to evaluate the 52-week results of adding sitagliptin to metformin monotherapy on HbA1c, fasting blood glucose (FBG) and body weight (BW).

Materials and Methods: The study included 44 patients who were treated with sitagliptin and continued to sitagliptin for 12 months while receiving metformin monotherapy. Age, sex, weight, body mass index,FBG, HbA1c, urea, creatinine, total cholesterol, triglyceride, LDL, HDL, alanine aminotransferase and aspartate aminotrensferase parameters were evaluated.

Results: The mean age of the 44 patients included in the study was 58.5 ± 8.9 years. Initially, BWand BMI were80.36 ± 11.72 kg and 31.14 ± 5.16 kg / m²; respectively. The initial HbA1c level was 7.5 ± 0.64%. The rates of HbA1cdecline according to the initial level were 0.82%, 0.86% and 0.9% at 3th, 6th and 12th months; respectively. There were statistically significant results when the baseline HbA1c level was compared to 3th, 6th and 12th months’ HbA1c levels. FBG level decreased 23.65 mg /dl, 26.07 mg / dl and 23.55 mg / dl at 3th, 6th and 12th months; respectively. There were also statistically significant results when the baseline FBG level was compared to 3th, 6th and 12th months’ FBG levels. It was observed that the decline in the FBG continued steadily during 12 months.

Conclusion: Addition of sitagliptin to treatment is an effective and well tolerated option in patients with type 2 diabetes who are not able to achieve adequate glycemic control despite metformin monotherapy (especially HbA1c level 7-8%).

Keywords

• Fasting Plazma Glucose,HbA1c,Metformin

Tip 2 Diyabet Hastalarının Tedavilerine Sitagliptin Eklenmesinin Glisemik Kontrol Üzerine Etkisi

Öz

Amaç: Bir dipeptidil peptidaz-4 (DPP-4) inhibitörü olan sitagliptin, metformin tedavisine ek olarak kullanıldığında etkili ve iyi tolere edilen inkretin temelli bir tedavidir. Sitagliptinin metformin monoterapisine eklenmesinin HbA1c, açlık kan şekeri(AKŞ) ve vücut ağırlığı(VA) üzerine 52 haftalık sonuçlarını değerlendirmeyi amaçladık.

Materyal ve Metot: Çalışmaya metformin monoterapisi alırken tedavisine sitagliptin eklenen ve 12 ay boyunca sitagliptin tedavisine devam eden 44 hasta dahil edildi. Olgularda yaş, cinsiyet, kilo, vücut kitle indeksi (VKİ), AKŞ, HbA1c, üre, kreatinin, total kolesterol, trigliserit, LDL, HDL, alanin aminotransferaz ve aspartat aminotrensferaz parametreleri değerlendirmeye alındı.

Bulgular: Çalışmaya alınan 44 hastanın ortalama yaşı 58,5±8,9 yıl idi. Başlangıçta, VA: 80,36±11,72 kg ve VKİ: 31,14±5,16 kg/m2 idi. Başlangıçtaki HbA1c düzeyi: % 7,5±0,64 olarak saptandı. HbA1c seviyesinin başlangıç değerlere göre düşüş oranının sırasıyla 3. ayda % 0,82; 6.ayda %0,86 ve 12. ayda % 0, 9 olduğu görüldü. HbA1c düşüşü başlangıca göre tüm aylarda istatistiksel olarak anlamlı bulundu. AKŞ seviyesinde başlangıç değerlerine göre sırasıyla 3. ayda 23,65 mg/dl, 6.ayda 26,07 mg/dl ve 12. ayda 23,55 mg/dl düşme olduğu görüldü. AKŞ’de düşüş, başlangıç değerleri ile karşılaştırıldığında tüm aylarda istatistiksel olarak anlamlıydı. AKŞ düşüşün 12 ay boyunca istikrarlı bir şekilde devam ettiği görüldü.

Sonuç: Metformin monoterapisi kullanımına rağmen yeterli glisemik kontrol sağlanamayan (özellikle HbA1c düzeyi %7-8) tip 2 diyabetli hastalarda tedaviye sitagliptin eklenmesi etkin ve iyi tolere edilen bir seçenektir.

Anahtar Kelimeler

• HbA1c,Metformin,Sitagliptin,açlık kan şekeri

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