Possible Long-Term Efficacy of Sitagliptin, a Dipeptidyl Peptidase-4 Inhibitor, for Slowly Progressive Type 1 Diabetes (SPIDDM) in the Stage of Non-Insulin-Dependency: An Open-Label Randomized Controlled Pilot Trial (SPAN-S)

被引：45

作者：

Awata, Takuya ^{[1
]}

Shimada, Akira ^{[2
]}

Maruyama, Taro ^{[3
]}

Oikawa, Yoichi ^{[2
]}

Yasukawa, Nobuyuki ^{[1
]}

Kurihara, Susumu ^{[2
]}

Miyashita, Yumi ^{[4
]}

Hatano, Masako ^{[2
]}

Ikegami, Yuichi ^{[2
]}

Matsuda, Masafumi ^{[5
]}

Niwa, Masataka ^{[6
]}

Kazama, Youichiro ^{[7
]}

Tanaka, Shoichiro

Kobayashi, Tetsuro

机构：

[1] Int Univ Hlth & Welf Hosp, Dept Diabet Endocrinol & Metab, Nasushiobara, Tochigi, Japan

[2] Saitama Med Univ, Fac Med, Dept Endocrinol & Diabet, Saitama, Japan

[3] Saitama Social Insurance Hosp, Dept Internal Med, Saitama, Japan

[4] Saitama Med Univ, Biomed Res Ctr, Div RI Lab, Saitama, Japan

[5] Saitama Med Univ, Saitama Med Ctr, Dept Endocrinol & Diabet, Saitama, Japan

[6] Iidabashi Med Clin, Tokyo, Japan

[7] Kazama Med Clin, Yamanashi, Japan

来源：

DIABETES THERAPY | 2017年 / 8卷 / 05期

关键词：

Dipeptidyl peptidase-4 (DPP-4); inhibitor; Intervention; Latent autoimmune diabetes in adults (LADA); Prevention; Sitagliptin; Slowly progressive type 1 diabetes (SPIDDM); Type; 1; diabetes; BETA-CELL FUNCTION; DOUBLE-BLIND; CLINICAL CHARACTERISTICS; COMBINATION THERAPY; ADULTS; ONSET; MELLITUS; MULTICENTER; DEFINITION; METFORMIN;

D O I：

10.1007/s13300-017-0299-7

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Introduction: We tested the hypothesis that dipeptidyl peptidase-4 (DPP-4) inhibitors are effective in preserving the beta-cell function for long-term periods in patients with slowly progressive type 1 diabetes (SPIDDM) or latent autoimmune diabetes in adults (LADA). Methods: In the present open-label, randomized, controlled trial, 14 non-insulin-requiring diabetic patients with glutamic acid decarboxylase autoantibodies (GADAb) were randomly assigned to receive either sitagliptin (S group) or pioglitazone (P group). As a historical control, the Tokyo Study, in which non-insulin-dependent patients with SPIDDM were assigned to receive treatment by either insulin or sulfonylurea (SU), was used. Results: On average, the aC-peptide values during the oral glucose tolerance test through the follow-up periods showed a nonsignificant increase in the S group (n = 6, n = 5 at 48 months) compared to the P group (n = 5, n = 2 at 48 months). In comparison to the data in the Tokyo Study, treatment by sitagliptin significantly influenced the longitudinal changes in the aC-peptide values with a more increased direction than insulin or SU, especially in patients with 48 months of follow-up (p = 0.014 and p = 0.007, respectively). Although the titers of GADAb were not significantly different between the S and P groups during the study, the change ratio of the GADAb titers from baseline was significantly inversely correlated with the change ratio of the aC-peptide values from baseline in the S group (p = 0.003); in particular, when the GADAb titers decreased from baseline, the aC-peptide values frequently increased. Conclusion: The present pilot trial suggests that treatment of SPIDDM/LADA by sitagliptin, a DPP-4 inhibitor, may be more effective in preserving the beta-cell function than insulin treatment for at least 4 years, possibly through the immune modulatory effects of DPP-4 inhibitors.

引用

页码：1123 / 1134

页数：12

共 40 条

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