Soliman Amin R, Fathy Ahmed, Khashab Sahier, Shaheen Noha, Soliman Mahmoud A
Department of Nephrology, Cairo University, Cairo, Egypt.
Exp Clin Transplant. 2013 Dec;11(6):494-8. doi: 10.6002/ect.2013.0018.
The aim of this study was to evaluate the effectiveness of sitagliptin, alone or in combination with metformin, in kidney transplant patients with newly diagnosed new-onset diabetes mellitus after transplant who had inadequate glycemic control, compared with a group of patients receiving insulin glargine with special emphasis on weight gain.
Newly diagnosed renal transplant patients with new-onset diabetes mellitus after a transplant was defined by a blood glucose ≥ 11.1 mmol/L after an oral glucose tolerance test were examined. They were treated with standard immunosuppression composed of triple therapy with tacrolimus or cyclosporine, mycophenolate mofetil or azathioprine, and prednisone. They had stable graft function for more than 6 months after the transplant.
Patients with new-onset diabetes mellitus after transplant (n=28) whose glycemia was not controlled adequately with oral hypoglycemic agents (either alone or in combination) received oral sitagliptin 100 mg once daily in addition to existing therapy for 12 weeks. Patients who received insulin glargine as add-on therapy (n=17) served as the control group. Data analyses included glycated hemoglobin, fasting plasma glucose, lipid profile, body weight, and the occurrence of hypoglycemia. We found significant reductions in glycated hemoglobin and fasting plasma glucose values after 12 weeks of additional sitagliptin therapy that were comparable to those with insulin glargine. While the addition of stagliptin resulted in a small weight loss (0.4 kg), the addition of insulin glargine resulted in a weight gain (0.8 kg). The overall incidence of adverse experiences was low and generally mild in both groups.
In a group of renal transplant recipients with new-onset diabetes mellitus after a transplant in whom glycemia was not controlled adequately by oral hypoglycemic agents, the addition of sitagliptin helped to achieve glycemic control similar to insulin glargine but with a marginal weight advantage.
本研究旨在评估西他列汀单药治疗或与二甲双胍联合治疗，对移植后新诊断为新发糖尿病且血糖控制不佳的肾移植患者的有效性，并与接受甘精胰岛素治疗的患者组进行比较，特别关注体重增加情况。
对口服葡萄糖耐量试验后血糖≥11.1 mmol/L的新诊断为移植后新发糖尿病的肾移植患者进行检查。他们接受由他克莫司或环孢素、霉酚酸酯或硫唑嘌呤以及泼尼松三联疗法组成的标准免疫抑制治疗。移植后6个月以上移植肾功能稳定。
移植后新发糖尿病患者（n = 28），单用或联用口服降糖药血糖控制不佳，在现有治疗基础上，加用口服西他列汀100 mg，每日1次，治疗12周。接受甘精胰岛素作为附加治疗的患者（n = 17）作为对照组。数据分析包括糖化血红蛋白、空腹血糖、血脂、体重和低血糖的发生情况。我们发现，额外使用西他列汀治疗12周后，糖化血红蛋白和空腹血糖值显著降低，与使用甘精胰岛素的效果相当。虽然加用西他列汀导致体重略有减轻（0.4 kg），但加用甘精胰岛素导致体重增加（0.8 kg）。两组不良事件的总体发生率较低，且一般较轻。
在一组移植后新发糖尿病且口服降糖药无法充分控制血糖的肾移植受者中，加用西他列汀有助于实现与甘精胰岛素相似的血糖控制，但在体重方面略有优势。
