Objective: Preclinical studies have shown that DPP-4 inhibitors (iDPP4) have beneficial effects on functional mass of beta cells and pancreatic insulin content. The aim of this study is to evaluate the efficacy of treatment with sitagliptin in monotherapy or in combination with insulin in person with type 1 diabetes (DM-1) or type LADA diabetes (DM-LADA) of recent diagnosis.
Patients and methods: Descriptive study: patients with DM-1 or DM-LADA in treatment with sitagliptin in monotherapy or in combination with insulin at diagnosis. Variables analyzed at baseline and at 6 and 12 months: type diabetes, age, sex, Body mass index (BMI), HbA1c, C-peptide, pancreatic autoimmunity (anti-GAD Antibody, anti-IA2 Antibody), treatment and adverse effects. Statistical analysis: ANOVA for comparison of means and McNemar for omparison of proportions.
Results: 17 patients. 70.6% DM-1 (10 DM-1 patients with positive pancreatic autoimmunity and 2 negative pancreatic autoimmunity), 29.4% DM-LADA. Initial treatment: basal insulin + prandial insulin 35.29% (n=6), basal insulin + sitagliptin 29.41% (n=5), sitagliptin in monotherapy 35.29% (n=6). Treatment at 12 months: basal insulin + prandial insulin 29.41% (n=5), basal insulin + sitagliptin 23.52% (n=4), sitagliptin in monotherapy 47.05% (n=8). No adverse effects. Treatment at 12 months basal insulin + prandial insulin vs basal insulin + sitagliptin vs sitagliptin in monotherapy: age 39.60±16 vs 37±4.69 vs 32.5±10.26 years (P=0.54); BMI initial 24.33±3.59 vs 27.37±4.75 vs 24.88±2.76 Kg/m2 (P=0.41); HbA1c initial 10.40±3.55 vs 11±2.12 vs 10.62±3.04% (P=0.95); C-peptide initial 0.65±0.36 vs 0.60±0.53 vs 0.61±0.20 pmol/ml (P=0.96); level of anti-GAD antibody 708.34±822.51 vs 526.50±982.59 vs 339.93±733.16 U/ml (P=0.32); BMI at 12 months 24.44±3.92 vs 27.54±6.05 vs 24.54±2.56 Kg/m2 (P=0.41); HbA1c at 12 months 6.62±0.37 vs 6.27±0.45 vs 6.13±0.60% (P=0.36). DM-1 with positive pancreatic autoimmunity 100% (n=5) vs 75% (n=3) vs 25% (n=2), DM-1 with negative pancreatic autoimmunity only sitagliptin in monotherapy 25% (n=2), DM-LADA 0% vs 25% (n=1) vs 50% (n=4)) (P=0.89); women 80% (n=4) vs 25% (n=1) vs 37.5% (n=3) (P=0.19).
Conclusions: Sitagliptin monotherapy achieves optimal metabolic control in almost half of patients with DM-1 or DM-LADA. The response to sitagliptin monotherapy is not related to any initial parameter. No adverse effects were observed in patients treated with sitagliptina in monotherapy.
18 - 21 May 2019
European Society of Endocrinology