The efficacy of incretin therapy in patients with type 2 diabetes undergoing hemodialysis

Abstract

BackgroundAlthough incretin therapy is clinically available in patients with type 2 diabetes undergoing hemodialysis, no study has yet examined whether incretin therapy is capable of maintaining glycemic control in this group of patients when switched from insulin therapy. In this study, we examined the efficacy of incretin therapy in patients with insulin-treated type 2 diabetes undergoing hemodialysis.MethodsTen type 2 diabetic patients undergoing hemodialysis received daily 0.3 mg liraglutide, 50 mg vildagliptin, and 6.25 mg alogliptin switched from insulin therapy on both the day of hemodialysis and the non-hemodialysis day. Blood glucose level was monitored by continuous glucose monitoring. After blood glucose control by insulin, patients were treated with three types of incretin therapy in a randomized crossover manner, with continuous glucose monitoring performed for each treatment.ResultsDuring treatment with incretin therapies, severe hyperglycemia and ketosis were not observed in any patients. Maximum blood glucose and mean blood glucose on the day of hemodialysis were significantly lower after treatment with liraglutide compared with treatment with alogliptin (p < 0.05), but not with vildagliptin. The standard deviation value, a marker of glucose fluctuation, on the non-hemodialysis day was significantly lower after treatment with liraglutide compared with treatment with insulin and alogliptin (p < 0.05), but not with vildagliptin. Furthermore, the duration of hyperglycemia was significantly shorter after treatment with liraglutide on both the hemodialysis and non-hemodialysis days compared with treatment with alogliptin (p < 0.05), but not with vildagliptin.ConclusionsThe data presented here suggest that patients with type 2 diabetes undergoing hemodialysis and insulin therapy could be treated with incretin therapy in some cases.

Prescription of oral hypoglycemic agents for patients with type 2 diabetes mellitus: A retrospective cohort study using a Japanese hospital database

“…There are many benefits of incretin therapy, such as pancreatic b-cell preservation, lower risk of weight gain and fewer hypoglycemic attacks. In addition, incretin is a therapeutic option for the treatment of type 2 diabetes, even during end-stage renal disease [19][20][21] . In the present study, DPP-4Is were stopped during 2 years in 80% of cases.…”

Exendin-4, a GLP-1 Receptor Agonist, Attenuates Prostate Cancer Growth

“…There are many benefits of incretin therapy, such as pancreatic b-cell preservation, lower risk of weight gain, and fewer hypoglycemic attacks (35). In addition, incretin is a therapeutic option for the treatment of type 2 diabetes, even during end-stage renal disease (36). Furthermore, incretin therapy is expected to have tissue-protective effects beyond its glucose-lowering capacity (1).…”

Liraglutide relieves cardiac dilated function than DPP‐4 inhibitors

“…Consequently, reduced GFR limits the choice of antidiabetic agents. Novel incretin enhancing agents have been evaluated in DM patients with renal impairment 2, 3, 4. The available agents enhance incretin activity by acting as glucagon‐like peptide‐1 (GLP‐1) receptor agonists or as dipeptidyl peptidase‐4 (DPP‐4) inhibitors.…”

“…Novel incretin enhancing agents have been evaluated in DM patients with renal impairment. [2][3][4] The available agents enhance incretin activity by acting as glucagon-like peptide-1 (GLP-1) receptor agonists or as dipeptidyl peptidase-4 (DPP-4) inhibitors. This study investigated the effects of a GLP-1 analogue (liraglutide) and two DPP-4 inhibitors (sitagliptin and linagliptin) on cardiac function in a series of DM patients with impaired renal function.…”