Efficacy and safety of combination therapy with vildagliptin and metformin versus metformin uptitration in Chinese patients with type 2 diabetes inadequately controlled with metformin monotherapy: a randomized, open‐label, prospective study (<scp>VISION</scp>)

Ji, Linong; Pan, Changyu; Lu, Juming; Li, Hong; Zhu, Dalong; Li, Qiang; Li, Qifu; Peng, Yongde; Tian, Haoming; Yao, Chen; Zhao, Zhigang; Wang, Le; Wang, Bin‐Hui

doi:10.1111/dom.12667

Cited by 19 publications

(18 citation statements)

References 32 publications

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“…inhibitor and insulin has been demonstrated in previous studies, the intervention time in those studies was between 24 weeks and 2 years [13][14][15][16][17]. Our results show that the MBG level and the BG level after meals were ameliorated when vildagliptin was added to CSII monotherapy during our short-term treatment period of 7 days, with a significant difference in the MBG manifesting from the third day onwards.…”

Section: Discussionsupporting

confidence: 78%

“…Data are presented as the mean ± standard deviation (SD). MBG refers to the MBG concentration of each day during treatment because pharmacologic action augments the GLP-1 effect [13,23]. Additionally, previous studies have indicated that vildagliptin as addon therapy to various insulin regimens (but not including CSII) can decrease daily insulin doses and improve glycemic control without weight gain [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

“…Dipeptidyl peptidase-4 (DPP-4) inhibitors can increase the plasma level of endogenous incretins by preventing their inactivation, thereby modifying insulin secretion from b-cells and glucagon release from a-cells in a glucosedependent manner [12]. In one study, the DDP-4 inhibitor vildagliptin as an add-on to insulin treatment for 24 months was well tolerated and led to sustained reductions in glycated hemoglobin (HbA1c), the dose and number of insulin injections and the risk of hypoglycemia [13]. However, reports on the efficacy of adding vildagliptin to short-term insulin therapy are rare.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Vildagliptin Added to Continuous Subcutaneous Insulin Infusion (CSII) in Hospitalized Patients with Type 2 Diabetes

Lyu

Huang

et al. 2020

Diabetes Ther

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Introduction: The aim of this study was to compare the efficacy of vildagliptin as add-on therapy to short-term continuous subcutaneous insulin infusion (CSII) with CSII monotherapy in hospitalized patients with type 2 diabetes mellitus (T2DM). Methods: A total of 200 hospitalized patients with inadequately controlled T2DM were randomized into groups, with one group receiving CSII monotherapy (CSII group, n =100) and the other group receiving CSII plus vildagliptin as add-on (CSII ? Vig group, n = 100). Of these, 191 completed the 7-day trial (CSII group, n = 99; CSII ? Vig group, n = 92) and included in the analysis. The glycemic control and variability of the patients were measured using allday capillary blood glucose (BG) monitoring. Weight and fasting C-peptide levels were evaluated before and after the interventions. Results: Mean BG concentrations during the whole treatment period were lower and the time to reach target BG was reduced in the CSII ? Vig group compared with the CSII group (9.89 ± 3.37 vs. 9.46 ± 3.23 mmol/L, P \ 0.01; 129 ± 4 vs. 94 ± 5 h, P \ 0.01, respectively). Similarly, the indicators of glycemic variability, namely the standard deviation of BG and the largest amplitude of glycemic excursion, were significantly decreased in the CSII ? Vig group compared with the CSII group (2.68 ± 1.05 vs. 2.39 ± 1.00 mmol/L, P \ 0.01; 7.19 ± 2.86 vs. 6.23 ± 2.73 mmol/L, P \ 0.01, respectively). Conclusions: Short-term CSII with vildagliptin as add-on therapy may be an optimized treatment for hospitalized patients with T2DM compared with short-term CSII monotherapy.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of Vildagliptin Added to Continuous Subcutaneous Insulin Infusion (CSII) in Hospitalized Patients with Type 2 Diabetes

Lyu

Huang

et al. 2020

Diabetes Ther

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“…Clinical trials in Chinese patients with T2DM have shown that metformin can decrease HbA1c by 0.7% to 1.0% . However, no significant difference was observed in glucose control between metformin alone and low‐dose metformin plus DPP‐4 inhibitors . The UKPDS study results showed that metformin also decreased the likelihood of cardiovascular events and death in obese patients with T2DM .…”

Section: Pharmacologic Therapy For Hyperglycaemiamentioning

confidence: 99%

Standards of medical care for type 2 diabetes in China 2019

Jia

Weng

Zhu

et al. 2019

Diabetes Metabolism Res

510

452

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Summary The prevalence of diabetes in China has increased rapidly from 0.67% in 1980 to 10.4% in 2013, with the aging of the population and westernization of lifestyle. Since its foundation in 1991, the Chinese Diabetes Society (CDS) has been dedicated to improving academic exchange and the academic level of diabetes research in China. From 2003 to 2014, four versions of Chinese diabetes care guidelines have been published. The guidelines have played an important role in standardizing clinical practice and improving the status quo of diabetes prevention and control in China. Since September 2016, the CDS has invited experts in cardiovascular diseases, psychiatric diseases, nutrition, and traditional Chinese medicine to work with endocrinologists from the CDS to review the new clinical research evidence related to diabetes over the previous 4 years. Over a year of careful revision, this has resulted in the present, new version of guidelines for prevention and care of type 2 diabetes in China. The main contents include epidemiology of type 2 diabetes in China; diagnosis and classification of diabetes; primary, secondary, and tertiary diabetes prevention; diabetes education and management support; blood glucose monitoring; integrated control targets for type 2 diabetes and treatments for hyperglycaemia; medical nutrition therapy; exercise therapy for type 2 diabetes; smoking cessation; pharmacologic therapy for hyperglycaemia; metabolic surgery for type 2 diabetes; prevention and treatment of cardiovascular and cerebrovascular diseases in patients with type 2 diabetes; hypoglycaemia; chronic diabetic complications; special types of diabetes; metabolic syndrome; and diabetes and traditional Chinese medicine.

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“…In patients already treated with glyburide (glibenclamide), nausea and diarrhoea were more common in those also receiving metformin; these adverse effects were severe in ≤1% and 4% to 5% of patients, respectively . In Chinese patients inadequately controlled with metformin monotherapy who were uptitrated to 1 g twice daily, 4.4% of patients experienced GI AEs …”

Section: Prevalence Of Metformin‐associated Gi Adverse Eventsmentioning

confidence: 99%

Understanding and overcoming metformin gastrointestinal intolerance

Bonnet

Scheen

2017

Diabetes Obesity Metabolism

182

108

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Metformin is the most widely prescribed drug for patients with type 2 diabetes mellitus and the first-line pharmacological option as supported by multiple international guidelines, yet a rather large proportion of patients cannot tolerate metformin in adequate amounts because of its associated gastrointestinal (GI) adverse events (AEs). GI AEs typically encountered with metformin therapy include diarrhoea, nausea, flatulence, indigestion, vomiting and abdominal discomfort, with diarrhoea and nausea being the most common. Although starting at a low dose and titrating slowly may help prevent some GI AEs associated with metformin, some patients are unable to tolerate metformin at all and it may also be difficult to convince patients to start metformin again after a bout of GI AEs. Despite this clinical importance, the underlying mechanisms of the GI intolerance associated with metformin are poorly known. In the present review, we discuss: the epidemiology of metformin-associated GI intolerance and its underlying mechanisms; genotype variability and associated factors affecting metformin GI intolerance, such as comorbidities, co-medications and bariatric surgery; clinical consequences and therapeutic strategies to overcome metformin GI intolerance. These strategies include appropriate titration of immediate-release metformin, use of extended-release metformin, the promise of delayed-release metformin and gut microbiome modulators, as well as alternative pharmacological therapies when metformin cannot be tolerated at all. Given the available data, all efforts should be made to maintain metformin before considering a shift to another drug therapy.

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Efficacy and safety of combination therapy with vildagliptin and metformin versus metformin uptitration in Chinese patients with type 2 diabetes inadequately controlled with metformin monotherapy: a randomized, open‐label, prospective study (VISION)

Abstract: VLDM was non-inferior and statistically superior to HDM in glycaemic control in Chinese patients with T2DM inadequately controlled with low-dose metformin.

Cited by 19 publications

References 32 publications

Efficacy of Vildagliptin Added to Continuous Subcutaneous Insulin Infusion (CSII) in Hospitalized Patients with Type 2 Diabetes

Efficacy of Vildagliptin Added to Continuous Subcutaneous Insulin Infusion (CSII) in Hospitalized Patients with Type 2 Diabetes

Standards of medical care for type 2 diabetes in China 2019

Understanding and overcoming metformin gastrointestinal intolerance

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