The effectiveness of ingibitors of dipeptidylpeptidazy type 4 in combination with metformin in patients with type 2 diabetes mellitus and obesity
Keywords:ingibitors of dipeptidylpeptidazy type 4, metformin, type 2 diabetes mellitus, obesity
Endocrinology: News, Opinions, Training. 2014; (3): 98
Objective: To evaluate the effect of inhibitors of dipeptidyl peptidase type 4 as a part of combination therapy with metformin on metabolic parameters of patients with diabetes mellitus type 2 and obesity.
Methods: fasting glycemiс level, postprandial hyperglycemia, glycosylated hemoglobin, weight, BMI, waist circumference, femora circumference, waist circumference, ratio of femora circumference to waist circumference, total cholesterol, triglycerides, LDL, HDL, insulin, insulin resistance using the index HOMA IR, functional activity of β-cells by index HOMA-B were evaluated in dynamics.
Results: 30 patients with diabetes mellitus type 2, poor glycemic control (HbA1c>7%), obesity, lipid disorders, initially not receiving medical therapy (n=14), or who are receiving metformin monotherapy at a dose of 1,5–2 g / day (16 people) were investigated. Average age is 54,2 years and from 35 to 75 years. All patients were prescribed combination therapy with 100 mg of sitagliptin daily and metformin at a dose of 2 g per day, in the form medication Yanumet 0,05 / 1,0 (Merck Sharp & Doum, USA). Initially: mean body weight of 97,6 kg (77–140 kg), mean body mass index of 34,5 (28–43,8 kg/m2), the average waist size 111,12 cm (90–127cm), medium hips 116,86 cm (111–134cm). Mean levels of total cholesterol, 6,7 mmol/l triglycerides -4,0 mmol/l, LDL -4,5 mmol/l HDL -1,0 mmol/l, fasting glycemia 8.5 mmol/l, postprandial glycemia 11,01 mmol/l glycated hemoglobin 8%. All patients have adipose tissue distributed of abdominal type. In 3 months there was a decrease in glycated hemoglobin by 1,36% fasting glycemia by 1,24 mmol/l, postprandial glycemia by 2,37 mmol/l, body weight by 3,4 kg, BMI, by 1,01 kg/m2, waist size by 5,12 cm, the hips by 3,06 cm, HOMA IR index by 1,45, the total cholesterol levels by 1,28 mmol/l, triglycerides, by 0,8 mmol/l, low density lipoproteins by 0,94 mmol/l, increasing HDL levels by 0,2 mmo/l, functional activity of β-cells, HOMA B by 11,4. During the treatment hypoglycemia was not fixed.
Conclusions: prescription of sitagliptin + metformin combination to patients with diabetes mellitus type 2, noncompensated by receiving of monotherapy with metformin or diet therapy, overweight and lipid disorders showed efficiency in reaching target HbA1c and was characterized by positive nonglycemic pleiotropic effects.