Tanimoto Masumi, Kanazawa Akio, Hirose Takahisa, Yoshihara Tomoaki, Kobayashi-Kimura Saeko, Nakanishi Risa, Tosaka Yuka, Sasaki-Omote Ruri, Kudo-Fujimaki Kyoko, Komiya Koji, Ikeda Fuki, Someya Yuki, Mita Tomoya, Fujitani Yoshio, Watada Hirotaka
Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine Tokyo, Japan.
Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine Tokyo, Japan ; Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine Tokyo, Japan.
J Diabetes Investig. 2015 Sep;6(5):560-6. doi: 10.1111/jdi.12338. Epub 2015 Mar 15.
AIMS/INTRODUCTION: Dipeptidyl peptidase-4 inhibitors and glinides are effective in reducing postprandial hyperglycemia. However, little information is available on the comparative effects of the two drugs on the levels of postprandial glucose. The aim of the present study was to compare the effects of sitagliptin and nateglinide on meal tolerance tests in drug-naïve patients with type 2 diabetes mellitus.
The study participants were 19 patients with type 2 diabetes mellitus, which was inadequately controlled by diet and exercise. An open-label, prospective, cross-over trial was carried out to compare the effects of single-dose sitagliptin and nateglinide on the postprandial glucose level and its related hormones during meal tests.
The change in area under the curve (AUC) of glucose from 0 to 180 min (AUC0-180 min) during the meal test by nateglinide was similar to that by sitagliptin. As expected, the change in active glucagon like peptide-1 was significantly higher after a single-dose of sitagliptin than nateglinide. Then, insulin secretion relative to glucose elevation (ISG) (ΔISG0-180 min: ΔAUC0-180 min insulin/AUC0-180 min glucose) was significantly enhanced by nateglinide compared with sitagliptin. Conversely, glucagon level (ΔAUC0-180 min glucagon) was increased by administration of nateglinide, whereas the glucagon level was reduced by administration of sitagliptin.
The effects of sitagliptin on postprandial glucose levels were similar to those of nateglinide in drug-naïve type 2 diabetes patients. However, the induced changes in insulin, active glucagon-like peptide-1 and glucagon during meal loading suggest that reduction of postprandial hyperglycemia was achieved by the unique effect of each drug.
目的/引言：二肽基肽酶-4抑制剂和格列奈类药物在降低餐后高血糖方面有效。然而，关于这两种药物对餐后血糖水平的比较效果，目前所知甚少。本研究的目的是比较西他列汀和那格列奈对初治2型糖尿病患者进行餐耐量试验的影响。
研究参与者为19例2型糖尿病患者，其病情通过饮食和运动控制不佳。开展了一项开放标签、前瞻性、交叉试验，以比较单剂量西他列汀和那格列奈在餐试验期间对餐后血糖水平及其相关激素的影响。
那格列奈在餐试验期间0至180分钟的葡萄糖曲线下面积（AUC）变化与西他列汀相似。正如预期的那样，单剂量西他列汀后活性胰高血糖素样肽-1的变化显著高于那格列奈。然后，与西他列汀相比，那格列奈显著增强了相对于葡萄糖升高的胰岛素分泌（ISG）（ΔISG0-180分钟：ΔAUC0-180分钟胰岛素/AUC0-180分钟葡萄糖）。相反，那格列奈给药后胰高血糖素水平（ΔAUC0-180分钟胰高血糖素）升高，而西他列汀给药后胰高血糖素水平降低。
在初治2型糖尿病患者中，西他列汀对餐后血糖水平的影响与那格列奈相似。然而，进餐负荷期间胰岛素、活性胰高血糖素样肽-1和胰高血糖素的诱导变化表明，每种药物通过独特的作用实现了餐后高血糖的降低。
