Use of Sitagliptin With Closed-Loop Technology to Decrease Postprandial Blood Glucose in Type 1 Diabetes

Underland, Lisa; Ilkowitz, Jeniece; Katikaneni, Ranjitha; Dowd, A.; Heptulla, Rubina A.

doi:10.1177/1932296817699847

Cited by 20 publications

(13 citation statements)

References 24 publications

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“…Other potential oral adjunctive medications include dipeptidyl peptidase‐4 inhibitors such as sitagliptin, which was recently shown to decrease BG after the first 2 meals in the setting of closed‐loop insulin delivery over 25 hours in 15 patients with no significant effect on glucagon levels . SGLT2 inhibitors belong to a new class of oral anti‐diabetic medications that act by increasing renal glucose excretion, and may potentially be combined with CLS to improve glucose control.…”

Section: Challenges and Technical Issuesmentioning

confidence: 99%

The challenges of achieving postprandial glucose control using closed‐loop systems in patients with type 1 diabetes

Gingras

Taleb

Roy‐Fleming

et al. 2017

Diabetes Obesity Metabolism

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For patients with type 1 diabetes, closed-loop delivery systems (CLS) combining an insulin pump, a glucose sensor and a dosing algorithm allowing a dynamic hormonal infusion have been shown to improve glucose control when compared with conventional therapy. Yet, reducing glucose excursion and simplification of prandial insulin doses remain a challenge. The objective of this literature review is to examine current meal-time strategies in the context of automated delivery systems in adults and children with type 1 diabetes. Current challenges and considerations for post-meal glucose control will also be discussed. Despite promising results with meal detection, the fully automated CLS has yet failed to provide comparable glucose control to CLS with carbohydrate-matched bolus in the post-meal period. The latter strategy has been efficient in controlling post-meal glucose using different algorithms and in various settings, but at the cost of a meal carbohydrate counting burden for patients. Further improvements in meal detection algorithms or simplified meal-priming boluses may represent interesting avenues. The greatest challenges remain in regards to the pharmacokinetic and dynamic profiles of available rapid insulins as well as sensor accuracy and lag-time. New and upcoming faster acting insulins could provide important benefits. Multi-hormone CLS (eg, dual-hormone combining insulin with glucagon or pramlintide) and adjunctive therapy (eg, GLP-1 and SGLT2 inhibitors) also represent promising options. Meal glucose control with the artificial pancreas remains an important challenge for which the optimal strategy is still to be determined.

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Section: Challenges and Technical Issuesmentioning

confidence: 99%

The challenges of achieving postprandial glucose control using closed‐loop systems in patients with type 1 diabetes

Gingras

Taleb

Roy‐Fleming

et al. 2017

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

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“…One study looked at the effects of sitagliptin on postprandial glucose levels in those with type 1 diabetes treated with a closed-loop system. In this small study, the authors found a statistically significant decrease in postprandial glucose when sitagliptin was added, and they commented that insulin delivery was lower in the sitagliptin group [ 64 ]. No adverse events were reported by the authors, and there was no significant difference in the rate of hypoglycaemia between groups.…”

Section: Dpp-4 Inhibitorsmentioning

confidence: 99%

Metabolic Control in Type 1 Diabetes: Is Adjunctive Therapy the Way Forward?

et al. 2018

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Despite advances in insulin therapies, patients with type 1 diabetes (T1DM) have a shorter life span due to hyperglycaemia-induced vascular disease and hypoglycaemic complications secondary to insulin therapy. Restricting therapy for T1DM to insulin replacement is perhaps an over-simplistic approach, and we focus in this work on reviewing the role of adjuvant therapy in this population. Current data suggest that adding metformin to insulin therapy in T1DM temporarily lowers HbA1c and reduces weight and insulin requirements, but this treatment fails to show a longer-term glycaemic benefit. Agents in the sodium glucose co-transporter-2 inhibitor (SGLT-2) class demonstrate the greatest promise in correcting hyperglycaemia, but there are safety concerns in relation to the risk of diabetic ketoacidosis. Glucagon-like peptide-1 agonists (GLP-1) show a modest effect on glycaemia, if any, but significantly reduce weight, which may make them suitable for use in overweight T1DM patients. Treatment with pramlintide is not widely available worldwide, although there is evidence to indicate that this agent reduces both HbA1c and weight in T1DM. A criticism of adjuvant studies is the heavy reliance on HbA1c as the primary endpoint while generally ignoring other glycaemic parameters. Moreover, vascular risk markers and measures of insulin resistance—important considerations in individuals with a longer T1DM duration—are yet to be fully investigated following adjuvant therapies. Finally, studies to date have made the assumption that T1DM patients are a homogeneous group of individuals who respond similarly to adjuvant therapies, which is unlikely to be the case. Future longer-term adjuvant studies investigating different glycaemic parameters, surrogate vascular markers and harder clinical outcomes will refine our understanding of the roles of such therapies in various subgroups of T1DM patients.

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“…DPP-4 inhibitors decrease postprandial hyperglycemia not only in T2DM but also in T1D [133]. In HIV + patients with impaired glucose tolerance who are on combination antiretroviral therapy, sitagliptin favorably improved inflammation, chronic immune cell activation and reduced glucose area under the curve [134].…”

Section: Clinical Studiesmentioning

confidence: 99%

Pharmacology of dipeptidyl peptidase-4 inhibitors and its use in the management of metabolic syndrome: a comprehensive review on drug repositioning

et al. 2019

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Objectives Despite advances in our understanding of metabolic syndrome (MetS) and the treatment of each of its components separately, currently there is no single therapy approved to manage it as a single condition. Since multi-drug treatment increases drug interactions, decreases patient compliance and increases health costs, it is important to introduce single therapies that improve all of the MetS components. Evidence acquisition We conducted a PubMed, Scopus, Google Scholar, Web of Science, US FDA, utdo.ir and clinicaltrial.gov search, gathered the most relevant preclinical and clinical studies that have been published since 2010, and discussed the beneficial effects of dipeptidyl peptidase (DPP)-4 inhibitors to prevent and treat different constituent of the MetS as a single therapy. Furthermore, the pharmacology of DPP-4 inhibitors, focusing on pharmacodynamics, pharmacokinetics, drug interactions and their side effects are also reviewed. Results DPP-4 inhibitors or gliptins are a new class of oral anti-diabetic drugs that seem safe drugs with no severe side effects, commonly GI disturbance, infection and inflammatory bowel disease. They increase mass and function of pancreatic β-cells, and insulin sensitivity in liver, muscle and adipose tissue. It has been noted that gliptin therapy decreases dyslipidemia. DPP-4 inhibitors increase fatty oxidation, and cholesterol efflux, and decrease hepatic triglyceride synthase and de novo lipogenesis. They delay gastric emptying time and lead to satiety. Besides, gliptin therapy has anti-inflammatory and anti-atherogenic impacts, and improves endothelial function and reduces vascular stiffness. Conclusion The gathered data prove the efficacy of DPP-4 inhibitors in managing MetS in some levels beyond anti-diabetic effects. This review could be a lead for designing new DPP-4 inhibitors with greatest effects on MetS in future. Introducing drugs with polypharmacologic effects could increase the patient's compliance and decrease the health cost that there is not in multi-drug therapy.

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Use of Sitagliptin With Closed-Loop Technology to Decrease Postprandial Blood Glucose in Type 1 Diabetes

Abstract: Sitagliptin may be considered as an adjunct therapy in a closed-loop setting. Larger studies are needed to determine the role of oral agents like sitagliptin to lower postprandial hyperglycemia with closed loop.

Cited by 20 publications

References 24 publications

The challenges of achieving postprandial glucose control using closed‐loop systems in patients with type 1 diabetes

The challenges of achieving postprandial glucose control using closed‐loop systems in patients with type 1 diabetes

Metabolic Control in Type 1 Diabetes: Is Adjunctive Therapy the Way Forward?

Pharmacology of dipeptidyl peptidase-4 inhibitors and its use in the management of metabolic syndrome: a comprehensive review on drug repositioning

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