Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
Endocr J. 2011;58(11):979-87. doi: 10.1507/endocrj.ej11-0025. Epub 2011 Sep 15.
The potent and selective dipeptidyl peptidase-4 inhibitor vildagliptin improves glycemic control in patients with type 2 diabetes through incretin hormone-mediated increases in both α- and β-cell responsiveness to glucose. We conducted a prospective, open-label, parallel group, controlled study of 51 patients with type 2 diabetic patients undergoing hemodialysis (HD) during the 24-week study period. Patients were assigned to two groups: the vildagliptin group (n = 30) and the control group (n = 21). Vildagliptin was administered at 50 mg/day for the first 8 weeks. Then doses were titrated by dose-doubling to a maximum of 100 mg/day if hemoglobin A1c (HbA1c) or glycated albumin (GA) target levels had not been reached. No vildagliptin was administered to the controls. The average final dose of vildagliptin was 80 ± 5 mg daily. After 24 weeks, vildagliptin had decreased average HbA1c levels from 6.7 % baseline to 6.1 %, average GA levels from 24.5 % baseline to 20.5 % and average postprandial plasma glucose levels from 186 mg/dL baseline to 140 mg/dL (all p < 0.0001). In the control group, we observed no such changes. Vildagliptin efficacy did not differ according to age or body mass index, but the GA reduction was significantly greater in the anti-diabetic agents-naïve group. Furthermore, in patients with higher baseline GA levels, a higher vildagliptin dosage was required to produce a noticeable effect. No serious adverse effects such as hypoglycemia or liver impairment were observed in any patient. Vildagliptin was effective as a treatment for diabetic patients undergoing HD.
强效、选择性二肽基肽酶-4 抑制剂维格列汀通过增加肠降血糖素激素介导的α-和β细胞对葡萄糖的反应性，改善 2 型糖尿病患者的血糖控制。我们进行了一项为期 24 周的前瞻性、开放标签、平行组、对照研究，纳入了 51 例正在接受血液透析（HD）的 2 型糖尿病患者。患者被分为两组：维格列汀组（n = 30）和对照组（n = 21）。在最初的 8 周内，维格列汀的剂量为 50 mg/天。如果未达到血红蛋白 A1c（HbA1c）或糖化白蛋白（GA）目标水平，则通过剂量加倍滴定剂量，最高剂量为 100 mg/天。对照组未给予维格列汀。维格列汀的平均最终剂量为 80 ± 5 mg/天。24 周后，维格列汀降低了平均 HbA1c 水平（从基线的 6.7%降至 6.1%）、平均 GA 水平（从基线的 24.5%降至 20.5%）和平均餐后血浆葡萄糖水平（从基线的 186 mg/dL 降至 140 mg/dL，均 p < 0.0001）。在对照组中，我们没有观察到这种变化。维格列汀的疗效与年龄或体重指数无关，但在初治抗糖尿病药物组中，GA 降低更为显著。此外，在基线 GA 水平较高的患者中，需要更高的维格列汀剂量才能产生明显的效果。任何患者均未观察到低血糖或肝损伤等严重不良事件。维格列汀作为治疗接受 HD 的糖尿病患者是有效的。
