Use of Sitagliptin With Closed-Loop Technology to Decrease Postprandial Blood Glucose in Type 1 Diabetes.

Autor:	Underland LJ; 1 Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital at Montefiore, Bronx, NY, USA., Ilkowitz JT; 1 Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital at Montefiore, Bronx, NY, USA.; 2 Department of Pediatrics, Division of Diabetes, NYU Lagone Medical Center, New York, NY USA., Katikaneni R; 1 Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital at Montefiore, Bronx, NY, USA., Dowd A; 1 Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital at Montefiore, Bronx, NY, USA., Heptulla RA; 1 Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital at Montefiore, Bronx, NY, USA.
Jazyk:	angličtina
Zdroj:	Journal of diabetes science and technology [J Diabetes Sci Technol] 2017 May; Vol. 11 (3), pp. 602-610. Date of Electronic Publication: 2017 Mar 28.
DOI:	10.1177/1932296817699847
Abstrakt:	Background: Postprandial hyperglycemia poses a challenge to closed-loop systems. Dipeptidyl peptidase-4 (DPP-4) inhibitors, like sitagliptin, reduce postprandial glucose concentrations in patients with type 2 diabetes. The objective of this study was to assess sitagliptin's role in type 1 diabetes (T1DM) as an adjunct therapy in reducing postprandial blood glucose with an insulin-only closed-loop system. Methods: This was a randomized, double-blinded, placebo controlled, crossover design trial. The participants were18-35 years old, had T1DM, and an HbA1c of ≤ 8.5%. A dose determination study included eight subjects with T1DM. There were three study visits. Four hours after receiving study drug (placebo, sitagliptin 50 mg, sitagliptin 100 mg), subjects underwent a mixed meal tolerance test with assessment of hormone concentrations. In a second study, 15 subjects underwent two visits receiving either placebo or 100 mg of sitagliptin plus an insulin only closed-loop system for 25 hours with timed meals. Blood glucose and other hormone concentrations were analyzed using repeated measures ANOVA. Results: For the dose determination study, sitagliptin 100 mg resulted in reduced postprandial blood glucose ( P = .006). For the closed-loop study, glucose concentrations were lower in the treatment group, most prominently during the first two study meals ( P = .03). There was no difference in glucagon concentrations, but insulin concentrations and insulin delivery were lower in the treatment group. Conclusions: Sitagliptin may be considered as an adjunct therapy in a closed-loop setting. Larger studies are needed to determine the role of oral agents like sitagliptin to lower postprandial hyperglycemia with closed loop.
Databáze:	MEDLINE
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