Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, New York.
New York Obesity Research Center, Columbia University, New York, New York.
Diabetes Obes Metab. 2018 Apr;20(4):1018-1023. doi: 10.1111/dom.13139. Epub 2017 Nov 28.
The present study was a 4-week randomized trial to assess the efficacy and safety of sitagliptin, a dipeptidyl-peptidase-4 inhibitor, in persistent or recurring type 2 diabetes after Roux-en-Y gastric bypass surgery (RYGB). Participants (n = 32) completed a mixed meal test (MMT) and self-monitoring of plasma glucose (SMPG) before and 4 weeks after randomization to either sitagliptin 100 mg daily or placebo daily. Questionnaires were administered to assess gastrointestinal discomfort. Outcome variables were glucose, active glucagon-like peptide-1 and β-cell function during the MMT, and glucose levels during SMPG. Age (56.3 ± 8.2 years), body mass index (34.4 ± 6.7 kg/m ), glycated haemoglobin (7.21 ± 0.77%), diabetes duration (12.9 ± 10.0 years), years since RYGB (5.6 ± 3.3 years) and β-cell function did not differ between the placebo and sitagliptin groups at pre-intervention. Sitagliptin was well tolerated, decreased postprandial glucose levels during the MMT (from 8.31 ± 1.92 mmol/L to 7.67 ± 1.59 mmol/L, P = 0.03) and mean SMPG levels, but had no effect on β-cell function. In patients with diabetes and mild hyperglycemia after RYGB, a short course of sitagliptin provided a small but significant glucose-lowering effect, with no identified improvement in β-cell function.
本研究是一项为期 4 周的随机试验，旨在评估二肽基肽酶-4 抑制剂西他列汀在 Roux-en-Y 胃旁路手术后（RYGB）持续或复发 2 型糖尿病患者中的疗效和安全性。参与者（n=32）在随机分组前和分组后 4 周完成混合餐试验（MMT）和自我监测血浆葡萄糖（SMPG），分别每天服用西他列汀 100mg 或安慰剂。问卷调查用于评估胃肠道不适。主要观察指标为 MMT 期间的血糖、活性胰高血糖素样肽-1 和β细胞功能，以及 SMPG 期间的血糖水平。年龄（56.3±8.2 岁）、体重指数（34.4±6.7kg/m2）、糖化血红蛋白（7.21±0.77%）、糖尿病病程（12.9±10.0 年）、RYGB 后年限（5.6±3.3 年）和β细胞功能在干预前两组间无差异。西他列汀耐受良好，降低了 MMT 后餐后血糖水平（从 8.31±1.92mmol/L 降至 7.67±1.59mmol/L，P=0.03）和平均 SMPG 水平，但对β细胞功能无影响。在 RYGB 后糖尿病和轻度高血糖的患者中，短期应用西他列汀可产生较小但显著的降糖作用，β细胞功能未见改善。
