Shimoda Masashi, Miyoshi-Takai Maiko, Irie Shintaro, Tanabe Akihito, Obata Atsushi, Okauchi Seizo, Hirukawa Hidenori, Kimura Tomohiko, Kohara Kenji, Kamei Shinji, Mune Tomoatsu, Kaku Kohei, Kaneto Hideaki
Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan.
Division of General Internal Medicine 1, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan.
J Diabetes Res. 2017;2017:5856475. doi: 10.1155/2017/5856475. Epub 2017 May 25.
Dipeptidyl peptidase-4 (DPP-4) inhibitors are often used all over the world and exert various beneficial effects including glucose-lowering effect in many subjects with type 2 diabetes. It is poorly understood, however, which factors are closely related with the durability of glucose-lowering effect by DPP-4 inhibitor. In this study, we examined retrospectively which factors could mainly influence the durability of DPP-4 inhibitor. We enrolled 212 participants with type 2 diabetes to whom DPP-4 inhibitor was administered for over 1 year without an addition or increase of other hypoglycemic agents. Age and baseline HbA1c level were significantly higher in the effective group than those in the ineffective group. The effective group had a tendency of smaller amounts of weight change, average total cholesterol, and average triglyceride compared with the ineffective group. Multiple logistic regression analysis showed that average triglyceride and baseline HbA1c were independent predictors associated with the durability of DPP-4 inhibitor. Moreover, an average triglyceride level contributed to the durability of DPP-4 inhibitor in the obese group (BMI ≥ 25 kg/m) but not in the nonobese group (BMI < 25 kg/m). These results suggest the importance of strict triglyceride management to maintain the durability of glucose-lowering effect by DPP-4 inhibitor, especially in obese subjects with type 2 diabetes.
二肽基肽酶-4（DPP-4）抑制剂在全球范围内广泛使用，对许多2型糖尿病患者具有多种有益作用，包括降血糖作用。然而，人们对哪些因素与DPP-4抑制剂降血糖作用的持久性密切相关了解甚少。在本研究中，我们回顾性研究了哪些因素可能主要影响DPP-4抑制剂的持久性。我们纳入了212例接受DPP-4抑制剂治疗超过1年且未添加或增加其他降糖药物的2型糖尿病患者。有效组的年龄和基线糖化血红蛋白（HbA1c）水平显著高于无效组。与无效组相比，有效组的体重变化量、平均总胆固醇和平均甘油三酯有降低趋势。多因素logistic回归分析显示，平均甘油三酯和基线HbA1c是与DPP-4抑制剂持久性相关的独立预测因素。此外，平均甘油三酯水平对肥胖组（BMI≥25kg/m²）DPP-4抑制剂的持久性有影响，但对非肥胖组（BMI<25kg/m²）无影响。这些结果表明，严格控制甘油三酯水平对于维持DPP-4抑制剂的降血糖持久性很重要，尤其是在肥胖的2型糖尿病患者中。
