Mathieu Chantal, Degrande Evy
Department of Endocrinology, Katholieke Universiteit Leuven, UZ Gasthuisberg, Herestraat 49, Leuven, Belgium.
Vasc Health Risk Manag. 2008;4(6):1349-60. doi: 10.2147/vhrm.s3005.
Vildagliptin is a new oral antidiabetic agent that enhances pancreatic islet cell responsiveness to glucose. An extensive clinical program involving approximately 22,000 patients and 7000 patient-years of exposure to vildagliptin has shown that the agent is well tolerated and efficacious in improving glycemic control in patients with type 2 diabetes mellitus (T2DM). Monotherapy trials have shown that significant HbA1c lowering is accompanied by body weight-neutral and lipid-neutral effects, low risk of edema, and low risk of hypoglycemia. These characteristics make vildagliptin a favorable partner for combination therapy. Studies of vildagliptin as an add-on to metformin have shown significant improvements in glycemic control (comparable to that of thiazolidinedione add-on), with the combination being well tolerated and associated with low risks for hypoglycemia and adverse effects on weight or lipid levels. Good tolerability and clinically relevant improvements in glycemic control have also been observed with vildagliptin as an add-on treatment to sulfonylurea, thiazolidinedione, or insulin treatment or in initial combination treatment with pioglitazone. Improved beta-cell function and glycemic control have been shown with vildagliptin in subjects with impaired glucose tolerance and in T2DM patients with mild hyperglycemia, with some evidence in the latter suggesting the potential for modifying disease course.
维格列汀是一种新型口服抗糖尿病药物，可增强胰岛细胞对葡萄糖的反应性。一项广泛的临床研究涉及约22000名患者，维格列汀的暴露时间达7000患者年，结果表明该药物耐受性良好，在改善2型糖尿病（T2DM）患者血糖控制方面疗效显著。单药治疗试验表明，维格列汀在显著降低糖化血红蛋白（HbA1c）的同时，对体重和血脂无影响，水肿风险低，低血糖风险也低。这些特性使维格列汀成为联合治疗的理想选择。维格列汀与二甲双胍联合使用的研究表明，血糖控制有显著改善（与加用噻唑烷二酮类药物相当），联合用药耐受性良好，低血糖风险低，对体重或血脂水平无不良影响。维格列汀作为磺脲类、噻唑烷二酮类或胰岛素治疗的附加治疗药物，或与吡格列酮联合初始治疗时，也观察到良好的耐受性和血糖控制的临床相关改善。在糖耐量受损的受试者和轻度高血糖的T2DM患者中，维格列汀已显示出改善β细胞功能和血糖控制的效果，在后者中，一些证据表明其具有改变疾病进程的潜力。
