Hirata Takumi, Inukai Kouichi, Morimoto Jiro, Katayama Shigehiro, Ishida Hitoshi
Foundation for Biomedical Research and Innovation, Kobe, Japan.
Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
Prim Care Diabetes. 2014 Oct;8(3):265-70. doi: 10.1016/j.pcd.2014.01.008. Epub 2014 Feb 14.
We investigated to clarify factors associated with the efficacy of sitagliptin, a dipeptidyl peptidase (DPP)-IV inhibitor, for glycemic control including the confounding effect of concomitant drugs in patients with type 2 diabetes.
We included type 2 diabetes patients with HbA1c levels of ≥7% who were not under insulin treatment and were administered sitagliptin (50mg/day for 6 months). Reduction or discontinuation of insulin sensitizers was not permitted during the study period. Outcomes included HbA1c level variations and attaining a target HbA1c level of <7%. Associated factors with each outcome were examined using multivariate analysis.
Of the 313 patients enrolled in this study, 147 (47.0%) attained HbA1c levels of <7%. High baseline HbA1c levels were associated with HbA1c level variations but inversely associated with attaining the target HbA1c level of <7%. Concomitant use of an insulin sensitizer and a α-glucosidase inhibitor and maintenance of the baseline dose of concomitant drugs were significantly associated with each outcome.
Our results suggest that concomitant sitagliptin administration (50mg/day) will improve glycemic control if treatment is initiated before HbA1c levels deteriorate. Other medication should be continued at initiation of sitagliptin administration.
我们进行研究以阐明二肽基肽酶（DPP）-IV抑制剂西格列汀对血糖控制疗效的相关因素，包括2型糖尿病患者中合并用药的混杂效应。
我们纳入了糖化血红蛋白（HbA1c）水平≥7%、未接受胰岛素治疗且服用西格列汀（50毫克/天，持续6个月）的2型糖尿病患者。研究期间不允许减少或停用胰岛素增敏剂。观察指标包括HbA1c水平变化以及达到HbA1c目标水平<7%。使用多变量分析检查与每个观察指标相关的因素。
在本研究纳入的313例患者中，147例（47.0%）达到了HbA1c水平<7%。高基线HbA1c水平与HbA1c水平变化相关，但与达到HbA1c目标水平<7%呈负相关。同时使用胰岛素增敏剂和α-葡萄糖苷酶抑制剂以及维持合并用药的基线剂量与每个观察指标均显著相关。
我们的结果表明，如果在HbA1c水平恶化之前开始治疗，同时给予西格列汀（50毫克/天）将改善血糖控制。在开始使用西格列汀时应继续使用其他药物。
