Irie Yoko, Katakami Naoto, Mita Tomoya, Takahara Mitsuyoshi, Matsuoka Taka-Aki, Gosho Masahiko, Watada Hirotaka, Shimomura Iichiro
Department of Endocrinology and Diabetes, Osaka Police Hospital, 10-31 Kitayamacho, Tennoji-ku, Osaka, 543-0035, Japan.
Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
Diabetes Ther. 2018 Feb;9(1):317-329. doi: 10.1007/s13300-018-0367-7. Epub 2018 Jan 12.
Ultrasonic tissue characterization of the carotid wall using gray-scale median (GSM) reflects its composition and low-GSM plaque is considered to be unstable. The present study evaluated the effect of alogliptin, a dipeptidyl peptidase-4 inhibitor, on the longitudinal change in GSM, an index of the tissue characteristics of the carotid wall, in patients with type 2 diabetes (T2DM).
This is a post hoc subanalysis using data obtained from the SPEAD-A trial, a randomized controlled trial that demonstrated the beneficial effect of alogliptin treatment on the progression of carotid intima-media thickness in patients with T2DM with no past history of apparent cardiovascular disease. A total of 322 subjects (161 in the alogliptin treatment group and 161 in the conventional treatment group) were enrolled. The primary outcome was the change from baseline in mean GSM-CCA (common carotid artery) during the 104-week observation period.
Both alogliptin treatment and conventional treatment significantly increased the mean GSM-CCA (from 60.7 ± 12.3 to 65.9 ± 10.1, p < 0.001 and 58.8 ± 14.4-65.2 ± 12.2, p < 0.001, respectively) and there was no significant difference in changes in mean GSM-CCA between the treatment groups (p = 0.95). Additionally, there were no differences in the changes in the left and right GSM-CCA between the groups.
A post hoc subanalysis revealed an improvement of tissue characteristics in the carotid arterial wall in both the alogliptin treatment group and the conventional treatment group during the 104-week treatment period and that there was no significant difference between the treatment groups.
UMIN000019951.
使用灰度中位数（GSM）对颈动脉壁进行超声组织特征分析可反映其成分，低GSM斑块被认为不稳定。本研究评估了二肽基肽酶-4抑制剂阿格列汀对2型糖尿病（T2DM）患者颈动脉壁组织特征指标GSM纵向变化的影响。
这是一项事后亚组分析，使用的是从SPEAD-A试验获得的数据，该试验是一项随机对照试验，证明了阿格列汀治疗对无明显心血管疾病既往史的T2DM患者颈动脉内膜中层厚度进展的有益作用。共纳入322名受试者（阿格列汀治疗组161名，传统治疗组161名）。主要结局是在104周观察期内平均GSM-CCA（颈总动脉）相对于基线的变化。
阿格列汀治疗组和传统治疗组均显著增加了平均GSM-CCA（分别从60.7±12.3增加到65.9±10.1，p<0.001；从58.8±14.4增加到65.2±12.2，p<0.001），治疗组之间平均GSM-CCA的变化无显著差异（p=0.95）。此外，两组之间左右GSM-CCA的变化也无差异。
一项事后亚组分析显示，在104周的治疗期内，阿格列汀治疗组和传统治疗组的颈动脉壁组织特征均有改善，且治疗组之间无显著差异。
UMIN000019951。
