Comparison of the Effects of Continuous Subcutaneous Insulin Infusion and Add-On Therapy with Sitagliptin in Patients with Newly Diagnosed Type 2 Diabetes Mellitus

Abstract

To identify a new regimen to optimize treatment for patients with newly diagnosed type 2 diabetes (T2DM) by short-term continuous subcutaneous insulin infusion (CSII) alone. Methods. 60 patients with newly diagnosed T2DM were randomized into two groups (n = 30 each) and treated for 2 weeks with CSII alone (CSII group) or with CSII plus sitagliptin (CSII + Sig group). The glycemic variability of the patients was measured using a continuous glucose monitoring system (CGMS) for the last 72 hours. A standard meal test was performed before and after the interventions, and the levels of glycated albumin, fasting glucose, fasting C-peptide, postprandial 2 h blood glucose, and postprandial 2 h C-peptide were examined. Results. Compared with the CSII group, the indicators of glycemic variability, such as the mean amplitude of glycemic excursion (MAGE) and the standard deviation of blood glucose (SDBG), were decreased significantly in the CSII + Sig group. The changes before and after treatment in the C-peptide reactivity index (ΔCPI) and the secretory unit of islet in transplantation index (ΔSUIT) indicated a significant improvement in the CSII + Sig group. Conclusions. Add-on therapy with sitagliptin may be an optimized treatment for patients with newly diagnosed T2DM compared with short-term CSII alone.

Effects of DPP-4 Inhibitors on Blood Glucose Variability in Japanese Patients with Type 2 Diabetes on Maintenance Hemodialysis: A Prospective Observational Exploratory Study

“…Also, our data from the linear mixed-effects model showed a rapid BG drop during hemodialysis and a tendency for hypoglycemia in the subsequent nighttime period in maintenance hemodialysis patients with type 2 diabetes. Although DPP-4 inhibitors have been shown to improve BG variability in patients with type 2 diabetes in many randomized controlled trials (RCTs) [ 41 – 49 ] (see the table in the Electronic supplementary material), few studies have reported the same effect in maintenance hemodialysis patients [ 50 ]. Our study illustrates the usefulness of DPP-4 inhibitors in these patients.…”

“…The ability of DPP-4 inhibitors to suppress BG variability in patients with type 2 diabetes has been shown in studies using CGM [ 51 , 52 ]. Furthermore, several RCTs using CGM found that BG variability is suppressed more effectively by DPP-4 inhibitors than by other agents such as sulfonylureas [ 41 , 42 ] and sodium glucose cotransporter 2 inhibitors [ 43 – 45 ] or by combination with insulin therapy [ 46 – 49 ]. The patients in these RCTs who showed suppressed BG variability with DPP-4 inhibitors had a mean age of less than 60 years [ 42 – 44 , 46 , 48 , 49 ], had HbA1c > 7% [ 41 – 44 , 46 – 49 ], were drug naïve [ 41 , 49 ], or had used metformin only [ 41 – 43 , 46 ].…”

The role of insulin pump therapy for type 2 diabetes mellitus

“…Several studies have assessed the benefits obtained with the combination of CSII and glucose lowering agents in patients with T2D. Combination of sitagliptin with CSII for 2 weeks enabled attainment of similar glycemic targets versus CSII alone, but with lower glycemic variability and improved beta cell function . A study which randomized poorly controlled patients to CSII alone or CSII with the combination of exenatide for 3 days demonstrated increased glycemic variability with exenatide but reduced glucose AUC in an OGTT .…”

Chinese clinical guidelines for continuous glucose monitoring (2018 edition)

“…Overall, CGM is primarily recommended to patients with type 1 diabetes and those with type 2 diabetes on intensive insulin therapy or who experience dramatic glycemic variability. When appropriate, CGM can also be used in clinical research as a valuable tool for assessing and guiding treatment Real‐time CGM is mainly applicable to the following patients or conditions: children and adolescents with type 1 diabetes whose HbA 1c less than 7%.…”