The Effect of DPP4 Inhibitor on Glycemic Variability in Patients with Type 2 Diabetes treated with twice-daily Premixed Human Insulin

Florence Hui Sieng Tan; Chin Voon Tong; Xun Ting  Tiong; Bik Kui Lau; Yueh Chien Kuan; Huai Heng  Loh; Saravanan Vengadesa Pillai

doi:10.15605/jafes.036.02.11

Authors

Florence Hui Sieng Tan Sarawak General Hospital, Malaysia https://orcid.org/0000-0002-1258-6788
Chin Voon Tong Hospital Melaka, Malaysia https://orcid.org/0000-0002-2160-6154
Xun Ting Tiong Sarawak General Hospital, Malaysia https://orcid.org/0000-0001-7514-5077
Bik Kui Lau Sarawak General Hospital, Malaysia
Yueh Chien Kuan Sarawak General Hospital, Malaysia https://orcid.org/0000-0002-4869-430X
Huai Heng Loh University of Malaysia Sarawak (UNIMAS), Malaysia
Saravanan Vengadesa Pillai Hospital Melaka, Malaysia https://orcid.org/0000-0001-9916-0802

DOI:

https://doi.org/10.15605/jafes.036.02.11

Keywords:

glycemic variability, dipeptidyl peptidase 4 inhibitors, premixed human insulin, continuous glucose monitoring, type 2 diabetes mellitus

Abstract

Objective. To evaluate the effect of adding DPP4 inhibitor (DPP4-I) on glycemic variability (GV) in patients with type 2 diabetes mellitus (T2DM) treated with premixed human insulin (MHI).

Methodology. We conducted a prospective study in patients with T2DM on twice-daily MHI with or without metformin therapy. Blinded continuous glucose monitoring was performed at baseline and following 6 weeks of Vildagliptin therapy.

Results: Twelve patients with mean (SD) age of 55.8 (13.1) years and duration of disease of 14.0 (6.6) years were recruited. The addition of Vildagliptin significantly reduced GV indices (mmol/L): SD from 2.73 (IQR 2.12-3.66) to 2.11 (1.76-2.55), p=0.015; mean amplitude of glycemic excursions (MAGE) 6.94(2.61) to 5.72 (1.87), p=0.018 and CV 34.05 (8.76) to 28.19 (5.36), p=0.010. In addition, % time in range (3.9-10 mmol/l) improved from 61.17 (20.50) to 79.67 (15.33)%, p=0.001; % time above range reduced from 32.92 (23.99) to 18.50 (15.62)%, p=0.016; with reduction in AUC for hyperglycemia from 1.24 (1.31) to 0.47 (0.71) mmol/day, p=0.015. Hypoglycemic events were infrequent and the reduction in time below range and AUC for hypoglycemia did not reach statistical significance.

Conclusion. The addition of DPP4-I to commonly prescribed twice-daily MHI in patients with T2DM improves GV and warrants further exploration.

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Author Biographies

Florence Hui Sieng Tan, Sarawak General Hospital, Malaysia

Endocrine Unit, Department of Medicine

Chin Voon Tong, Hospital Melaka, Malaysia

Department of Medicine

Xun Ting Tiong, Sarawak General Hospital, Malaysia

Clinical Research Center

Bik Kui Lau, Sarawak General Hospital, Malaysia

Endocrine Unit, Department of Medicine

Yueh Chien Kuan , Sarawak General Hospital, Malaysia

Endocrine Unit, Department of Medicine

Huai Heng Loh, University of Malaysia Sarawak (UNIMAS), Malaysia

Faculty of Medicine and Health Sciences

Saravanan Vengadesa Pillai, Hospital Melaka, Malaysia

Department of Medicine

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