The Glucose-lowering Efficacy of Sitagliptin in Obese Japanese Patients with Type 2 Diabetes

• Published in: Internal Medicine 2017/03/15, Vol.56(6), pp.605-613
• Main Authors: Kodera, Ryo, Shikata, Kenichi, Nakamura, Akihiko, Okazaki, Satoru, Nagase, Ryo, Nakatou, Tatsuaki, Haisa, Shigeru, Hida, Kazuyuki, Miyashita, Katsuhiro, Makino, Hirofumi
• Format: Article
• Language: English
• Subjects: Aged; Blood Glucose - drug effects; Blood Glucose - metabolism; Body mass; Body Mass Index; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; dipeptidyl peptidase-4 inhibitor; Dipeptidyl-peptidase IV; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; Female; Glucose; Glucose metabolism; Glycated Hemoglobin A - drug effects; Glycated Hemoglobin A - metabolism; Hemoglobin; Homeostasis; Humans; Hypoglycemic agents; Hypoglycemic Agents - therapeutic use; Inhibitors; Internal medicine; Japan; Male; Middle Aged; obesity; Obesity - epidemiology; Original; Peptidase; Prospective Studies; Regression analysis; sitagliptin; Sitagliptin Phosphate - therapeutic use
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.56.7428

Objective Dipeptidyl peptidase-4 (DPP-4) inhibitors are the most frequently prescribed oral hypoglycemic agents in Japan. Although a relationship between the efficacy of DPP-4 inhibitors and the body mass index (BMI) has been reported, this relationship is controversial. We investigated whether the BMI value affects the glucose-lowering efficacy of sitagliptin in obese Japanese patients with type 2 diabetes. Methods One hundred sixty-two outpatients with inadequate glycemic control were divided into four groups based on their baseline BMI values. They were then treated with sitagliptin (a DPP-4 inhibitor) for 3 months and followed-up for 12 months. Results Sitagliptin significantly reduced the hemoglobin A1c level (HbA1c: -0.71±0.55%) after 3 months, and continued to reduce the HbA1c level until 12 months. There was no significant difference in the efficacy of sitagliptin among the four BMI groups. A multiple linear regression analysis indicated that the factors contributing to the change in the HbA1c level were the baseline level of HbA1c and the homeostasis model assessment of β-cell function (HOMA-β). In terms of the relationship between the baseline BMI value and the efficacy of sitagliptin treatment, the number of patients who responded to sitagliptin treatment after 3 months was lowest in the group of patients with the highest BMI values. A multiple logistic regression analysis revealed that the baseline HOMA-β function and HbA1c level and a baseline BMI value of ≥30 kg/m2 significantly contributed to the response to sitagliptin treatment. Conclusion The results indicated that sitagliptin treatment was effective in controlling glucose metabolism disorder in obese Japanese patients with type 2 diabetes. However, the efficacy of sitagliptin treatment might be attenuated in severely obese patients, such as those with a BMI value of ≥30 kg/m2.