Kelowna, BC, Canada.
Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden.
Front Endocrinol (Lausanne). 2023 May 24;14:1171886. doi: 10.3389/fendo.2023.1171886. eCollection 2023.
The purpose of this retrospective clinic chart review study was to determine the potential of a combination therapy (CT) consisting of γ-aminobutyric acid (GABA), a dipeptidyl peptidase-4 inhibitor (DPP-4i), and a proton pump inhibitor (PPI) to improve glycemic control as an adjunct to insulin therapy in patients with type 1 diabetes (T1D).
Nineteen patients with T1D on insulin therapy were treated with additional CT in oral form. Fasting blood glucose (FBG), HbA1c, insulin dose-adjusted HbA1c (IDA-A1c), daily insulin dose, insulin/weight ratio (IWR), and fasting plasma C-peptide were measured after 26-42 weeks of treatments.
FBG, HbA1c, IDA-A1c, insulin dose and IWR were all significantly decreased while plasma C-peptide was significantly increased by the CT. Treatment outcomes were further analyzed by separation of the 19 patients into two groups. One group started on the CT within 12 months of insulin treatment (early therapy, 10 patients) and another group started on this therapy only after 12 months of insulin treatment (late therapy, 9 patients). FBG, IDA-A1c, insulin dose, and IWR decreased significantly in both the early and late CT groups, however to a better extent in the early therapy group. Moreover, plasma C-peptide increased significantly only in the early therapy group, and 7 of the 10 patients in this group were able to discontinue insulin treatment while maintaining good glycemic control to study end compared with none of the 9 patients in the late therapy group.
These results support the concept that the combination of GABA, a DPP-4i and a PPI as an adjunct to insulin therapy improves glycemic control in patients with T1D, and that the insulin dose required for glycemic control can be reduced or even eliminated in some patients receiving this novel therapy.
本回顾性临床图表研究的目的是确定 γ-氨基丁酸（GABA）、二肽基肽酶-4 抑制剂（DPP-4i）和质子泵抑制剂（PPI）联合治疗（CT）作为 1 型糖尿病（T1D）患者胰岛素治疗的辅助手段，改善血糖控制的潜力。
19 名接受胰岛素治疗的 T1D 患者接受口服联合 CT 治疗。治疗 26-42 周后，测量空腹血糖（FBG）、HbA1c、胰岛素剂量调整的 HbA1c（IDA-A1c）、每日胰岛素剂量、胰岛素/体重比（IWR）和空腹血浆 C 肽。
CT 可显著降低 FBG、HbA1c、IDA-A1c、胰岛素剂量和 IWR，同时显著升高血浆 C 肽。通过将 19 名患者分为两组进一步分析治疗结果。一组患者在开始胰岛素治疗后 12 个月内开始 CT（早期治疗，10 例），另一组患者仅在胰岛素治疗 12 个月后开始 CT（晚期治疗，9 例）。早期和晚期 CT 组的 FBG、IDA-A1c、胰岛素剂量和 IWR 均显著下降，但早期治疗组下降幅度更大。此外，仅早期治疗组的血浆 C 肽显著升高，其中 10 例患者中有 7 例能够在保持良好血糖控制的情况下停止胰岛素治疗，而晚期治疗组的 9 例患者中无一例能够停药。
这些结果支持 GABA、DPP-4i 和 PPI 联合作为胰岛素治疗的辅助手段改善 T1D 患者血糖控制的概念，并且在接受这种新疗法的一些患者中，控制血糖所需的胰岛素剂量可以减少甚至消除。
