The dipeptidyl peptidase-4 (DPP-4) inhibitor vildagliptin improves glycemic control in type 2 diabetic patients undergoing hemodialysis

Abstract

Numerous drugs with different mechanisms of action are currently in use with the aim of improving glycemic control, and drugs with different pharmacologic profiles are employed in the management of type 2 diabetes. Therapeutic options for patients with type 2 diabetes and end-stage renal disease (ESRD) are, however, limited because the reduced glomerular filtration rate results in the accumulation of certain drugs and/ or their metabolites [1]. Conventional oral hypoglyce- Abstract. The potent and selective dipeptidyl peptidase-4 inhibitor vildagliptin improves glycemic control in patients with type 2 diabetes through incretin hormone-mediated increases in both α-and β-cell responsiveness to glucose. We conducted a prospective, open-label, parallel group, controlled study of 51 patients with type 2 diabetic patients undergoing hemodialysis (HD) during the 24-week study period. Patients were assigned to two groups: the vildagliptin group (n = 30) and the control group (n = 21). Vildagliptin was administered at 50 mg/day for the first 8 weeks. Then doses were titrated by dose-doubling to a maximum of 100 mg/day if hemoglobin A1c (HbA1c) or glycated albumin (GA) target levels had not been reached. No vildagliptin was administered to the controls. The average final dose of vildagliptin was 80 ± 5 mg daily. After 24 weeks, vildagliptin had decreased average HbA1c levels from 6.7 % baseline to 6.1 %, average GA levels from 24.5 % baseline to 20.5 % and average postprandial plasma glucose levels from 186 mg/dL baseline to 140 mg/dL (all p < 0.0001). In the control group, we observed no such changes. Vildagliptin efficacy did not differ according to age or body mass index, but the GA reduction was significantly greater in the anti-diabetic agents-naïve group. Furthermore, in patients with higher baseline GA levels, a higher vildagliptin dosage was required to produce a noticeable effect. No serious adverse effects such as hypoglycemia or liver impairment were observed in any patient. Vildagliptin was effective as a treatment for diabetic patients undergoing HD.

Pharmacokinetic considerations for the treatment of diabetes in patients with chronic kidney disease

“…In a pooled analysis of 38 studies where vildagliptin was given for weeks in patients with T2DM, the presence of mild RI did not adversely affect the safety of vildagliptin relative to patients with normal renal function 138 . Finally, vildagliptin was also effective and safe as a treatment for diabetic patients undergoing hemodialysis 139 or in patients with severe RI (eGFR < 30 mL/min/1.73 m² and longstanding T2DM not adequately controlled with insulin therapy 140 .…”

Glycated Albumin (GA) is More Advantageous than Hemoglobin A1c for Evaluating the Efficacy of Sitagliptin in Achieving Glycemic Control in Patients with Type 2 Diabetes

“…Based on these characteristics, the GA level is well suited as an indicator of the efficacy of antidiabetic drug therapy in patients with type 2 diabetes. The utility of GA has only been investigated in this regard in a few studies (11,14,20,21). In the present study, the percent reduction from baseline was significantly greater for GA than HbA1c at most observation time points.…”

Oral glucose lowering drugs in type 2 diabetic patients with chronic kidney disease

“…59 A prospective, open-label, parallel group, controlled study evaluated the efficacy and safety of vildagliptin in 51 Japanese diabetic patients undergoing hemodialysis. 60 After a 24-week period, no serious adverse effects such as hypoglycemia or liver impairment were observed in any patient. Vildagliptin was effective as a treatment for diabetic patients undergoing hemodialysis (decreased average HbA1c levels from 6.7% baseline to 6.1%, and average glycated albumin levels from 24.5% baseline to 20.5%, p <0.0001).…”