5 :: KDA, Korean Diabetes Association ::
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Subject    :    [2015 Dec;39(6)] Clinical Characteristics and Metabolic Predictors of Rapid Responders to Dipeptidyl Peptidase-4 Inhibitor as an Add-on Therapy to Sulfonylurea and Metformin
Writer KDA
Date 2016-01-07 15:53:28 Hit 5,943
Diabetes Metab J. 2015 Dec;39(6):489-497. English. Published online Nov 27, 2015.  http://dx.doi.org/10.4093/dmj.2015.39.6.489 
Copyright © 2015 Korean Diabetes Association
   
Clinical Characteristics and Metabolic Predictors of Rapid Responders to Dipeptidyl Peptidase-4 Inhibitor as an Add-on Therapy to Sulfonylurea and Metformin
Ye An Kim,1,2 Won Sang Yoo,3 Eun Shil Hong,1,4 Eu Jeong Ku,1,5 Kyeong Seon Park,1,6 Soo Lim,1,6 Young Min Cho,1 Kyong Soo Park,1 Hak Chul Jang,1,6 and Sung Hee Choi1,6
1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
2Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
3Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
4Department of Internal Medicine, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea.
5Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
6Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Corresponding author: Sung Hee Choi. Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea. Email: drshchoi@snu.ac.kr 
 
Received January 14, 2015; Accepted April 22, 2015.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

 
Abstract
Background

Dipeptidyl peptidase-4 (DPP-4) inhibitor add-on therapy is a new option for patients with inadequately controlled type 2 diabetes who are taking combined metformin and sulfonylurea (SU). We evaluated the efficacy and safety of this triple therapy and the characteristics of rapid responders and hypoglycemia-prone patients.

Methods

We included 807 patients with type 2 diabetes who were prescribed a newly added DPP-4 inhibitor to ongoing metformin and SU in 2009 to 2011. Glycemia and other metabolic parameters at baseline, 12, 24, and 52 weeks, as well as episodes of hypoglycemia were analyzed. Rapid responders were defined as patients with ≥25% reduction in glycosylated hemoglobin (HbA1c) within 12 weeks.

Results

At baseline, while on the submaximal metformin and SU combination, the mean HbA1c level was 8.4%. Twelve weeks after initiation of DPP-4 inhibitor add-on, 269 patients (34.4%) achieved an HbA1c level ≤7%. Sixty-six patients (8.2%, 47 men) were rapid responders. The duration of diabetes was shorter in rapid responders, and their baseline fasting plasma glucose (FPG), HbA1c, C-peptide, and homeostasis model assessment of insulin resistance were significantly higher. Patients who experienced hypoglycemia after taking DPP-4 inhibitor add-on were more likely to be female, to have a lower body weight and lower triglyceride and FPG levels, and to have higher homeostasis model assessment of β-cells.

Conclusion

An oral hypoglycemic triple agent combination including a DPP-4 inhibitor was effective in patients with uncontrolled diabetes. Proactive dose reduction of SU should be considered when a DPP-4 inhibitor is added for rapid responders and hypoglycemia-prone patients.

   

Keywords: Combination; Diabetes mellitus, type 2; Dipeptidyl-peptidase IV inhibitors; Hypoglycemia;Response; Sulfonylurea compounds

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