Efficiency of the DPP-4 inhibitors in combination with metformin in patients with diabetes mellitus type 2 and overweight

• Dinara G. Gusenbekova

Abstract

Objective – to evaluate the effect of sitagliptin in combination with metformin on glucose toxicity and lipotoxicity in patients with type 2 diabetes and obesity. Methods. The study involved 82 patients (55 women, 27 men, mean age 56,1±5,47 years) with obesity, lipid metabolism disorders, who have not reached target levels HbA1s (average HbA1c 8,3±1,6%) on monotherapy with metformin and diet therapy. The first group of patients (42 people) received coformulated drug, consisting of sitagliptin 100 mg with metformin 2 g once a day; the second group (comparison) of patients (40 people) received metformin 1,5–2,0 g/day. Initially and in 6 months all patients were evaluated in dynamics with their level of fasting glycemia, postprandial glycemia, glycated hemoglobin, weight, BMI, WC, WHR, insulin, leptin, adiponectin, insulin resistance using the index HOMA IR, the functional activity of β-cells by the index HOMA-β. Results. After 6 months, patients in both groups were marked by significant positive changes in levels of fasting glucose, postprandial glycemia and glycosylated hemoglobin. In group I, there was a decrease in HbA1c from 8,3±1,6 to 6,6±1,24% (p<0,01) in group II there was a decrease from 8,35±1,75 to 7,62±1,39% (p<0,01). FPG and late products of glycosylation levels in group I decreased on average by 2,67 and 3,3 mmol/l, respectively, in group II by 2,1 and 1,8 mmol/l, in group I IRI decreased by 3,45 mcU/ml, in group II 1.63 mcU/ml (p=0,05). HOMA – increased in group I by 23,4 standard units, in group II by 4,8 standard units (p<0,005). There are no significant differences between the groups in the dynamics of HOMA IR. Positive dynamics in both groups is marked. A significant difference in the dynamics of adiponectin levels between the groups is marked, there was an increase by 1,9 ng/ml in group I, in group II by 0,49 ng/ml (p<0,01). Leptin decreased by 7,37 ng/ml in group I, in group II by 1,21 ng/ml (p<0,01). There are significant differences in the dynamics between the groups in anthropometric parameters (p<0,001). Weight reduced by 4,9±3,2 kg in group I, in group II by 2,0±0,94 kg on average. BMI in group I decreased by 1,8±1,3, in group II by 0,68±0,3. WC decreased by 6,5±4,7 cm in group I, in group II by 2,42±1,02 cm. WHR in group I, decreased from 0,95±0,06 to 0,91±0,05 cm, in group II from 0,94±0,03 to 0,93±0,03 cm. Episodes of hypoglycemia have not been recorded in any of the groups during the treatment.

Keywords:DPP-4, metformin, diabetes mellitus type 2, overweight

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