Effect of sitagliptin on glucose control in adult patients with Type 1 diabetes: a pilot, double-blind, randomized, crossover trial
Article first published online: 19 SEP 2011
© 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK
Volume 28, Issue 10, pages 1176–1181, October 2011
How to Cite
Ellis, S. L., Moser, E. G., Snell-Bergeon, J. K., Rodionova, A. S., Hazenfield, R. M. and Garg, S. K. (2011), Effect of sitagliptin on glucose control in adult patients with Type 1 diabetes: a pilot, double-blind, randomized, crossover trial. Diabetic Medicine, 28: 1176–1181. doi: 10.1111/j.1464-5491.2011.03331.x
- Issue published online: 19 SEP 2011
- Article first published online: 19 SEP 2011
- Accepted 2 May 2011
- dipeptidyl peptidase IV inhibitor;
- glucagon-like peptide 1;
- Type 1 diabetes
Diabet. Med. 28, 1176–1181 (2011)
Aims Patients with Type 1 diabetes have significantly elevated postprandial glucagon secretion. Dipeptidyl peptidase IV inhibitors improve HbA1c by several mechanisms, including increasing glucagon-like peptide 1 and glucose-dependent insulinotropic peptide concentrations, which decreases postprandial rises in glucagon in both Type 1 and Type 2 diabetes. This study evaluates the clinical implications of sitagliptin in adult patients with Type 1 diabetes.
Methods This investigator-initiated, double-blind, randomized, crossover, 8-week, pilot study enrolled 20 adult subjects with Type 1 diabetes. Subjects received sitagliptin 100 mg/day or placebo for 4 weeks and then crossed over. Outcomes included 2-h postprandial blood glucose and 24-h area under the curve changes in glucose measurements from continuous glucose monitoring, HbA1c, fructosamine and insulin dose.
Results Sitagliptin significantly reduced blood glucose (2-h postprandial and 24-h area under the curve) despite reduced total and prandial insulin dose. Based on continuous glucose monitor findings, sitagliptin improved measures of glycaemic control, including mean blood glucose (−0.6 mmol/l; P = 0.012) and time in euglycaemic range 4.4–7.8 mmol/l (0.4 ± 0.2 h; P = 0.046). Significant reductions were also observed in M100, Glycemic Risk Assessment Diabetes Equation (GRADE) and J-index. After controlling for period, treatment and insulin dose, the HbA1c was also significantly reduced [−0.27 ± 0.11% (−2.91 ± 1.16 mmol/mol); P = 0.025] when patients were taking sitagliptin.
Conclusions Sitagliptin significantly improved overall glucose control, including postprandial and 24-h glucose control, in adult patients with Type 1 diabetes, while significantly reducing prandial insulin requirements. Further investigation is warranted in patients with Type 1 diabetes in a larger cohort designed to assess both clinical outcomes and mechanism of action.