Predictive Clinical Parameters for the Therapeutic Efficacy of Sitagliptin in Korean Type 2 Diabetes Mellitus

Abstract

BackgroundSitagliptin is a highly selective dipeptidyl peptide-4 (DPP-4) inhibitor that increases blood levels of active glucagon-like peptide (GLP)-1 and glucose-dependent insulinotrophic polypeptide (GIP), resulting in increased insulin secretion. While studies conducted in other countries have indicated the efficacy and safety of using sitagliptin to treat type 2 diabetes mellitus (T2DM), its predictors of effects to sitagliptin are not well understood. Therefore, we evaluated the predictive clinical parameters for the therapeutic benefits of sitagliptin when added to an ongoing metformin or sulfonylurea therapy in Korean T2DM subjects.MethodsWe obtained data from 251 Korean T2DM subjects who had recently started taking sitagliptin as add-on therapy. Exclusion criteria included any insulin use. Changes in HbA1c (ΔHbA1c) and fasting plasma glucose (ΔFPG) were assessed by comparing baseline levels prior to sitagliptin administration to levels 12 and 24 weeks after treatment. Responders were defined as subjects who experienced decrease from baseline of >10% in ΔHbA1c or >20% in ΔFPG levels at 24 weeks.ResultsWe classified 81% of the subjects (204 out of 251) as responders. The responder group had a lower mean body mass index (23.70±2.40 vs. 26.00±2.26, P≤0.01) and were younger (58.83±11.57 years vs. 62.87±12.09 years, P=0.03) than the non-responder group.ConclusionIn Korean T2DM subjects, sitagliptin responders had lower body mass index and were younger compared to non-responders.

Low-dose glimepiride with sitagliptin improves glycemic control without dose-dependency in patients with type 2 diabetes inadequately controlled on high-dose glimepiride

“…However, Kim et al reported that sitagliptin responders had lower BMI and were younger than non-responders in Korean patients with type 2 diabetes [12]. Nomiyama et al reported that treatment with sitagliptin 50 mg/day for 24 weeks in a larger number of patients was especially effective in patients with higher baseline HbA1c, lower BMI, and shorter duration of diabetes [13] and similar results were reported by Maeda et al [14].…”

Long-term efficacy of sitagliptin for the treatment of type 2 diabetic patients in Japan

“…Among those, however, 18% patients revealed no reduction or even the increase of HbA1c levels after 3 months' sitagliptin treatment, comparable to the report from Korea [12]. After the stratification of patients into three groups according to the degree of HbA1c reduction, candidate factors were listed and evaluated in relation to the glucose-lowering effect of sitagliptin.…”

Baseline Body Mass Index and the Efficacy of Hypoglycemic Treatment in Type 2 Diabetes: A Meta-Analysis

“…Moreover, as reported by Jones et al [18], the addition of rosiglitazone to metformin was most effective in obese, insulin-resistant patients with type 2 diabetes. In DPP-4 inhibitors treated patients, two studies in Japanese patients [19] and in Korean T2DM subjects [20] suggested that DPP-4 inhibitor treatment efficacy was associated with a low baseline BMI. In GLP-1 receptor agonists treated patients, a study designed to identify predictors of response to liraglutide therapy in Japanese patients [21] concluded that the efficacy of liraglutide could be associated with BMI at baseline.…”