The effect of combination therapy of insulin glargine, metformin, and sitagliptin on insulin secretion, insulin resistance, and metabolic parameters in obese subjects with type 2 diabetes
Introduction. A combination of drugs is required for treatment of obese subjects with diabetes, due to multiple pathogenic mechanisms implicated in the development of both diabetes and obesity. Objective. Assessment of the effect of sitagliptin added to insulin glargine and metformin, in ob...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Serbian Medical Society
2016-01-01
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| Series: | Srpski Arhiv za Celokupno Lekarstvo |
| Subjects: | |
| Online Access: | http://www.doiserbia.nb.rs/img/doi/0370-8179/2016/0370-81791610497B.pdf |
| Summary: | Introduction. A combination of drugs is required for treatment of obese
subjects with diabetes, due to multiple pathogenic mechanisms implicated in
the development of both diabetes and obesity. Objective. Assessment of the
effect of sitagliptin added to insulin glargine and metformin, in obese
subjects with type 2 diabetes. Methods. A total of 23 obese subjects on
metformin and insulin glargine participated in the study. Titration of
insulin glargine during a one-month period preceded the addition of 100 mg of
sitagliptin daily. Body mass index, waist circumference, fasting, and
prandial glucose were measured monthly, lipids and hemoglobin A1c (HbA1c)
every three months, insulin, c-peptide and glucagon at the start and after
six months of treatment. Homeostatic models for insulin secretion (HOMA B)
and insulin resistance (HOMA IR) were calculated. Results. Participants were
58.65 Ѓ} 7.62 years of age with a body mass index of 35.06 Ѓ} 5.15 kg/m2,
waist circumference of 115.04 Ѓ} 15.5 cm, and the duration of diabetes of
4.11 Ѓ} 2.57 years. With the titration of insulin glargine, target fasting
glucose levels were not achieved. Waist circumference and body mass index
decreased during three months of sitagliptin treatment, thereafter remaining
stable. HbA1c decreased significantly after three and six months of therapy.
C-peptide increased significantly, while glucagon level fell. HOMA indexes
were unchanged. Conclusion. Sitagliptin can improve diabetes control and
induce modest weight loss in obese subjects poorly controlled on insulin
glargine and metformin. Titration of insulin glargine to optimal fasting
glucose values is a prerequisite of success of this combination therapy. |
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| ISSN: | 0370-8179 2406-0895 |