Effect of the Addition of Sitagliptin and Miglitol on Insulin-Treated Type 2 Diabetes

Kishimoto, Mitsumasa; Noda, Mitsuhiko

doi:10.1007/s13300-012-0011-x

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…A possible mechanism may be increased exposure of nutrients to the distal small intestine, where L-cells are located [ 32 , 34 – 36 ]. To confirm these results, we previously studied postprandial active GLP-1 levels in patients with type 2 diabetes treated with or without insulin and found that miglitol administration increased active GLP-1 levels in some, but not all, patients [ 10 , 11 ]. The effect of miglitol administration in the present study resulted in varying total or active GLP-1 levels in each patient, but no typical pattern was observed.…”

Section: Discussionmentioning

confidence: 92%

“…Alpha-glucosidase inhibitors (a-GIs), another type of oral antidiabetic drug, also attenuate postprandial blood glucose fluctuations by delaying the absorption of digested carbohydrates from the small intestine [ 7 – 9 ]. Considering the different mechanisms of DPP-4 inhibitors and α-GIs, their use in combination therapy is promising for improving glycemic control [ 10 , 11 ]. The present case study aimed at examining the efficacy, through the use of a continuous glucose monitoring system (CGMS) [ 12 – 14 ] and hormone measurements, of a DPP-4 inhibitor (anagliptin) [ 15 ], and an α-GI (miglitol) when added to ongoing insulin treatment in patients with type 2 diabetes mellitus.…”

Section: Introductionmentioning

confidence: 99%

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Additive Effects of Miglitol and Anagliptin on Insulin-Treated Type 2 Diabetes Mellitus: A Case Study

Kishimoto

Noda

2014

Clin Drug Investig

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The aim of this case study was to examine the efficacy of a dipeptidyl peptidase-4 inhibitor (anagliptin) and an α-glucosidase inhibitor (miglitol) when added to ongoing insulin treatment in patients with type 2 diabetes mellitus. Continuous glucose monitoring was performed in four Japanese insulin-treated inpatients with type 2 diabetes. Baseline data were collected on day 1. Miglitol was administered on days 2 and 3. On day 4, miglitol and anagliptin were coadministered before breakfast. On days 1, 3, and 5, blood was drawn for plasma glucose, serum C-peptide, plasma glucagon, total and active glucagon-like peptide-1 (GLP-1), and total and active glucose-dependent insulinotropic peptide (GIP) measurements. Coadministration of anagliptin with miglitol resulted in additional improvements in glycemic control over the entire day in three of the four patients. The C-peptide, glucagon, and total and active GLP-1 and GIP responded differently to the medications for each patient, suggesting interindividual differences in hormonal responses, which may be complicated by multifactorial effects.Electronic supplementary materialThe online version of this article (doi:10.1007/s40261-014-0260-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Additive Effects of Miglitol and Anagliptin on Insulin-Treated Type 2 Diabetes Mellitus: A Case Study

Kishimoto

Noda

2014

Clin Drug Investig

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“…These patients demonstrated a low rate of hypoglycemia and a slight weight reduction 43,55. We previously reported that the combination of sitagliptin and insulin therapy presented beneficial effects in stabilizing glycemic control by stimulating endogenous insulin secretion and suppressing glucagon secretion 60. Vilsbøll et al previously reported in a 24-week study that the addition of sitagliptin to ongoing insulin therapy resulted in significant improvements in glycemic control, in comparison with the placebo treatment, by improving β-cell responsiveness 61.…”

Section: Gliptin Treatments In Combination With Insulinmentioning

confidence: 98%

Teneligliptin: a DPP-4 inhibitor for the treatment of type 2 diabetes

Kishimoto¹

2013

DMSO

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104

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Dipeptidyl peptidase-4 (DPP-4) inhibitors have recently emerged as a new class of antidiabetic that show favorable results in improving glycemic control with a minimal risk of hypoglycemia and weight gain. Teneligliptin, a novel DPP-4 inhibitor, exhibits a unique structure characterized by five consecutive rings, which produce a potent and long-lasting effect. Teneligliptin is currently used in cases showing insufficient improvement in glycemic control even after diet control and exercise or a combination of diet control, exercise, and sulfonylurea- or thiazolidine-class drugs. In adults, teneligliptin is orally administered at a dosage of 20 mg once daily, which can be increased up to 40 mg per day. Because the metabolites of this drug are eliminated via renal and hepatic excretion, no dose adjustment is necessary in patients with renal impairment. The safety profile of teneligliptin is similar to those of other available DPP-4 inhibitors. However, caution needs to be exercised when administering teneligliptin to patients who are prone to QT prolongation. One study has reported that the postprandial blood glucose-lowering effects of teneligliptin administered prior to breakfast were sustained throughout the day, and the effects observed after dinner were similar to those observed after breakfast or lunch. Thus, although clinical data for this new drug are limited, this drug shows promise in stabilizing glycemic fluctuations throughout the day and consequently suppressing the progression of diabetic complications. However, continued evaluation in long-term studies and clinical trials is required to evaluate the efficacy and safety of the drug as well as to identify additional indications for its clinical use.

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“…We are also attempting to construct new regimens composed of basal insulin and multiple hypoglycemic agents, including DPP-4 inhibitors or GLP-1 analogs [32]. …”

Section: Discussionmentioning

confidence: 99%

“…To improve postprandial hypoglycemia, dipeptidyl peptidase-4 (DPP-4) inhibitors and GLP-1 analogs are other choices for use in combination with basal insulin [ 30 , 31 ]. We are also attempting to construct new regimens composed of basal insulin and multiple hypoglycemic agents, including DPP-4 inhibitors or GLP-1 analogs [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Improvement of both fasting and postprandial glycemic control by the two-step addition of miglitol and mitiglinide to basal insulin therapy: a pilot study

Ihana

Tsujimoto

Yamamoto‐Honda

et al. 2014

Diabetol Metab Syndr

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BackgroundCombination therapy consisting of basal insulin and oral hypoglycemic agents (OHAs) is effective for the treatment of type 2 diabetes (T2DM) that cannot be adequately controlled using OHAs alone. Though basal insulin with metformin or sulfonylurea is an effective therapy, it cannot reduce postprandial glycemia without the risk of hypoglycemia. We examined a two-step regimen consisting of the addition of postprandial hypoglycemic agents (an alpha-glucosidase inhibitor and a glinide) in patients whose T2DM was poorly controlled using basal insulin therapy.MethodsInpatients between the ages of 30–79 years who had T2DM and an HbA1c level of more than 7.0% were recruited. The patients were treated with once-daily insulin glargine with or without metformin, depending on the patient’s age and renal function. Insulin glargine was titrated to achieve a target fasting glucose level of 70–130 mg/dL as a first step (STEP0). If the 2-hour postprandial glucose (PBG) level was higher than the target of 180 mg/dL, miglitol treatment (150 mg/day) was initiated, with dose adjustments (75–225 mg) allowed depending on abdominal symptoms and the PBG (STEP1). If the PBG of the patients remained higher than the target after 3 days of treatment, mitiglinide (30 mg/day, titrated up to 60 mg) was added (STEP2). We then evaluated the proportion of patients who achieved the target PBG before and after the two-step regimen. Continuous Glucose Monitoring (CGM) was performed throughout the two-step protocol in most of the patients.ResultsOf the 16 patients who were recruited (median age, 67.0 [58.0-71.0] years; body mass index, 25.0 [22.0-27.9] kg/m2; HbA1c level at admission, 9.1% [8.35-10.4%]), 1 patient (6.25%) achieved the target PBG at STEP 0 and 14 patients (87.5%) had achieved the target PBG at the end of the treatment protocol (P = 0.002). CGM showed a significant decrease in the glucose level at each step of the protocol. The standard deviations in the CGM glucose levels for 24 hours, MAGE, and M-value also improved.ConclusionsThe two-step addition of postprandial hypoglycemic agents to basal insulin therapy is potentially effective and safe for decreasing both the fasting and postprandial glucose levels.

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Effect of the Addition of Sitagliptin and Miglitol on Insulin-Treated Type 2 Diabetes

Cited by 8 publications

References 27 publications

Additive Effects of Miglitol and Anagliptin on Insulin-Treated Type 2 Diabetes Mellitus: A Case Study

Additive Effects of Miglitol and Anagliptin on Insulin-Treated Type 2 Diabetes Mellitus: A Case Study

Teneligliptin: a DPP-4 inhibitor for the treatment of type 2 diabetes

Improvement of both fasting and postprandial glycemic control by the two-step addition of miglitol and mitiglinide to basal insulin therapy: a pilot study

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