Trust and VERIFY: the role of combined treatment with metformin and dipeptidyl peptidase-4 inhibitors in new-onset diabetes type 2

Diabetes is a progressive disease that manifests itself in hyperglycemia and is associated with macro- and microvascular complications. Stepwise approach to glucose-lowering therapy is now often questioned for two main reasons. First, the decision on intensifying the treatment requires the decompensation of carbohydrate metabolism. Second, this conception does not always meet the criteria of pathophysiological treatment, in particular, in patients who are newly diagnosed with diabetes type 2 and recommended with metformin monotherapy. The combination of metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors is a well-known strategy that effectively controls blood glucose level and preserves beta cell functions. VERIFY study has demonstrated that after a 5-year follow-up, median time to type 2 diabetes decompensation is 36.1 months in metformin group and 61.9 months in early combined treatment group (metformin plus vildagliptin) (p<0.0001). These findings can account for paradigm shift in treatment prescription for newly diagnosed type 2 diabetes in patients with HbA1c less than 1,0% of the target level.KEYWORDS: diabetes, glucose-lowering therapy, control of glycemia, combined treatment.FOR CITATION: Demidova T.Yu., Kozhevnikov A.A. Trust and VERIFY: the role of combined treatment with metformin and dipeptidyl peptidase-4 inhibitors in new-onset diabetes type 2. Russian Medical Inquiry. 2020;4(6):334–339. DOI: 10.32364/2587-6821-2020-4-6-334-339.

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Switching from Premixed Insulin To Basal Insulin Analogue For Type 2 Diabetes and Role of Dipeptidyl Peptidase-4 Inhibitors

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-0043-113453 ◽

2017 ◽

Vol 126 (05) ◽

pp. 268-276 ◽

Cited By ~ 2

Author(s):

Fernando Gómez-Peralta ◽

Cristina Abreu ◽

Gustavo Mora-Navarro ◽

Pilar López-Morandeira ◽

Esteban Pérez-Gutierrez ◽

...

Keyword(s):

Type 2 Diabetes ◽

Basal Insulin ◽

Insulin Analogue ◽

Dipeptidyl Peptidase ◽

Premixed Insulin ◽

Dipeptidyl Peptidase 4 ◽

Metformin Group ◽

Dipeptidyl Peptidase 4 Inhibitors

Abstract Introduction This study aimed to confirm the usefulness of basal insulin analogue plus oral antidiabetic drugs (OADs) for type 2 diabetes (T2D) patients inadequately controlled with premixed insulin with/without OADs and assess the role of dipeptidyl peptidase-4 (DPP-4) inhibitors within this regimen in clinical practice. Methods Spanish retrospective observational study that included 186 T2D patients with glycosylated hemoglobin (HbA1c) >7% (53 mmol/mol) despite premixed insulin with/without OADs who had been switched to basal insulin analogue plus OADs. Study data describing the situation before the treatment switch and 6 months later was retrospectively retrieved from patients’ medical charts. Results Switching to a basal insulin plus OADs decreased HbA1c (−1.0%, p<0.001), fasting (−38.1 mg/dl, p<0.001) and postprandial glycemia (−36.1 mg/dl, p<0.001), with reduced body weight (−1.1 kg, p<0.001) and hypoglycemic episodes (−17.5%, p<0.001). 68 (36.6%) patients received a basal insulin plus DPP-4 inhibitor±metformin and 74 (39.8%) plus metformin only. The DPP-4 inhibitor±metformin group showed a greater HbA1c reduction than the metformin group (1.3±1.4% vs. 0.9±1.0%, p=0.022), with no significant differences between groups in hypoglycemic episodes. Conclusions Basal insulin analogue plus OADs may be a useful treatment for type 2 diabetes patients inadequately controlled with premixed insulin. Administering DPP-4 inhibitors within this regimen may contribute to improve patients’ glycemia, with a favorable weight-change profile and without increasing hypoglycemia risk.

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Therapeutic Role of Dipeptidyl Peptidase-4 Inhibitors in COVID-19

10.47363/jvrr/2020(1)116 ◽

2020 ◽

pp. 1-4

Author(s):

Nasser Mikhail ◽

◽

Soma Wali ◽

Keyword(s):

Type 2 Diabetes ◽

Retrospective Studies ◽

Clinical Status ◽

Dipeptidyl Peptidase ◽

Therapeutic Role ◽

Dipeptidyl Peptidase 4 ◽

Beneficial Effects ◽

Dipeptidyl Peptidase 4 Inhibitors

Background: Limited retrospective data suggest that dipeptidyl peptidase-4 (DPP-4) inhibitors such as sitagliptin may decrease mortality in patients with type 2 diabetes hospitalized with coronavirus disease 2019 (COVID-19). Objective: To review the strength of evidence that supports possible therapeutic role of DPP-4 inhibitors in COVID-19. Methods: PUBMED search until October 10, 2020. Search terms included COVID-19, DPP-4 inhibitors, sitagliptin, CD26, mortality, diabetes. Retrospective studies, pertinent animal investigations and pre-print studies are reviewed. Results: Three retrospective studies have shown that use of DPP-4 inhibitors was associated with significant mortality reduction of approximately 56- 87% in patients with diabetes admitted with COVID-19. In addition, in one of these studies, the use of sitagliptin before hospitalization was associated with greater number of hospital discharges, improvement of clinical status, reduced risk of transfer to intensive care unit (ICU) and need for mechanical ventilation compared with patients who were not receiving sitagliptin. Moreover, there was significant decrease in some pro-inflammatory markers in the sitagliptin group. A small retrospective study of 9 patients who were taking a DPP-4 inhibitor prior to admission did not find any significant effect of DPP-4 inhibitors on mortality and clinical outcomes after hospitalization. Results of another small study suggested increase susceptibility to COVID-19, but not to its severity, in patients taking DPP-4 inhibitors. Conclusions: Weak evidence derived from observational studies suggests possible beneficial effects of DPP-4 inhibitors use in patients with type 2 diabetes and COVID-19. Randomized trials are urgently needed to clarify the efficacy and safety of DPP-4 inhibitors in patients with COVID-19 with and without type 2 diabetes

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Sulfonylureas in today’s blood glucose lowering therapy.New data on advantages and potential barriers of an “old” antidiabetic group

Orvosi Hetilap ◽

10.1556/oh.2015.30114 ◽

2015 ◽

Vol 156 (13) ◽

pp. 511-515

Author(s):

Gábor Winkler

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Glucose Lowering ◽

Dipeptidyl Peptidase 4 ◽

Sulfonylurea Compounds ◽

Drug Of Choice ◽

Antidiabetic Treatment ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Glucose Lowering Therapy

Sulfonylurea compounds have been basic elements of antidiabetic treatment in type 2 diabetes for a long time. However, with the introduction of incretin type insulin secretagogues it is often arises, whether is still there a place for sulfonylureas in the today’s therapy. To answer this question the author overviews general pharmaceutical characteristics of the sulfonylurea compounds as well as individual particularities of the second generation derivatives used at present in Hungary. The author details also the most important differences between incretin type drugs − first of all dipeptidyl peptidase-4 inhibitors − and sulfonylureas. On the basis of available data it can be concluded in accordance with the latest international guidelines, that sulfonylureas have still role in the blood glucose lowering therapy of type 2 diabetes, though they became somewhat pushed back among insulin secretagogue type drugs. If a sulfonylurea compound is the drug of choice, it is important to select the appropriate molecule (in case of normal renal function gliclazide or glimepiride). It is also important to re-educate the patient, as well as to apply the minimal dose providing the desired glycaemic effect. Orv. Hetil., 2015, 156(13), 511–515.

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Dipeptidyl peptidase 4 inhibitors in modern domestic practice

Medical Council ◽

10.21518/2079-701x-2020-7-14-18 ◽

2020 ◽

pp. 14-18

Author(s):

A. S. Ametov ◽

N. A. Chernikov ◽

O. A. Knyshenko

Keyword(s):

Diabetes Mellitus ◽

Diabetes Mellitus Type 2 ◽

Randomized Clinical Trials ◽

Combined Treatment ◽

Dipeptidyl Peptidase ◽

Low Risk ◽

Diabetes Mellitus Type ◽

Dipeptidyl Peptidase 4 ◽

Dipeptidyl Peptidase 4 Inhibitors

The choice of treatment of diabetes mellitus type 2 is personalized, based on modern Russian and international algorithms for management of such patients. Given the initial level of decompensation of the disease at the time of diagnosis (at the level of glycated hemoglobin), most patients with type 2 diabetes at the time of initiation of therapy requires the combined treatment, at least two antidiabetic drugs. In modern conditions, on the basis of evidence-based medicine, priority should be given to drugs with a low risk of hypoglycemic conditions and do not affect or reduce body weight. In this article we consider a class of inhibitors of dipeptidyl peptidase 4, which entered into clinical practice since 2006 for the treatment of patients suffering from diabetes mellitus type 2, with an emphasis on drugs used in the Russian Federation. Today in our country there are seven members of the class of inhibitors of dipeptidyl peptidase 4. The results of the major randomized clinical trials (SAVOR-TIMI 53, EXAMINE, TECOS, CAROLINA), which studied the cardiovascular safety of dipeptidyl peptidase 4 inhibitors, showed the intra class heterogeneity with respect to data on the frequency of hospitalizations due to chronic heart failure. Have proven cardiovascular neutrality in relation to the primary combined cardiovascular outcome was MACE, including cardiovascular death, nonfatal myocardial infarction and nonfatal stroke. A major problem is the choice of effective glucose-lowering therapy to special patient groups. Assign their profession the safety of drugs plays a key role. With its high efficiency and unique glucosidation mechanism of action, guaranteeing a low risk of hypoglycemia and high safety, the drugs of this group has firmly taken its niche among the priority hypoglycemic drugs.

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The Role of Dipeptidyl Peptidase-4 Inhibitors in the Management of Type 2 Diabetes

US Endocrinology ◽

10.17925/use.2007.00.1.47 ◽

2007 ◽

Vol 00 (01) ◽

pp. 47

Author(s):

Bogdan Balas ◽

Ralph A DeFronzo ◽

◽

Keyword(s):

Type 2 Diabetes ◽

Dipeptidyl Peptidase ◽

Dipeptidyl Peptidase 4 ◽

Dipeptidyl Peptidase 4 Inhibitors

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Chronic renal disease in patients with type 2 diabetes mellitus

Cardiosomatics ◽

10.26442/22217185.2019.2.190317 ◽

2019 ◽

Vol 10 (2) ◽

pp. 65-70 ◽

Cited By ~ 1

Author(s):

Nane E. Khachaturian

Keyword(s):

Diabetes Mellitus ◽

Renal Disease ◽

Chronic Renal Disease ◽

Self Monitoring ◽

Glucose Lowering ◽

Dipeptidyl Peptidase 4 ◽

Lowering Therapy ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Glucose Lowering Therapy

Diabetes mellitus (DM) type 2 (type 2 diabetes) is one of the most common non-infectious diseases worldwide. Chronic hyperglycemia is a leading factor in a development of vascular complications of diabetes which involve various organs, particularly the eyes, kidney, cardiovascular system and nervous system. One of the most common complications of DM is diabetic nephropathy. Presence of chronic renal disease in a patient with DM limits options of glucose-lowering therapy. Dipeptidyl peptidase-4 inhibitors are currently among medications of choice for glucose-lowering therapy in patients with chronic renal disease. All currently available dipeptidyl peptidase-4 inhibitors can be administrated to patients with end-stage kidney disease on dialysis, and a rate of their use is continuously increasing. Given a high risk of hypoglycemic conditions in patients with chronic renal disease, a regular self-monitoring of glycemia is an essential component of a treatment. Glucometer Contour Plus One is one of the most recent devices developed for self-monitoring of blood glucose. Its advantage over all other blood glucose meters is an ability to synchronize with a mobile application Contour™ Diabetes (Contour Diabetes).

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