Effects of Initial Combinations of Gemigliptin Plus Metformin Compared with Glimepiride Plus Metformin on Gut Microbiota and Glucose Regulation in Obese Patients with Type 2 Diabetes: The INTESTINE Study
The efficacy and safety of medications can be affected by alterations in gut microbiota in human beings. Among antidiabetic medications, incretin-based therapy such as dipeptidyl peptidase 4 inhibitors might affect gut microbiomes, which are related to glucose metabolism. This was a randomized, cont...
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MDPI AG
2023-01-01
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| Series: | Nutrients |
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| Online Access: | https://www.mdpi.com/2072-6643/15/1/248 |
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| author | Soo Lim Minji Sohn Jose C. Florez Michael A. Nauck Jiyoung Ahn |
| author_facet | Soo Lim Minji Sohn Jose C. Florez Michael A. Nauck Jiyoung Ahn |
| author_sort | Soo Lim |
| collection | DOAJ |
| description | The efficacy and safety of medications can be affected by alterations in gut microbiota in human beings. Among antidiabetic medications, incretin-based therapy such as dipeptidyl peptidase 4 inhibitors might affect gut microbiomes, which are related to glucose metabolism. This was a randomized, controlled, active-competitor study that aimed to compare the effects of combinations of gemigliptin–metformin vs. glimepiride–metformin as initial therapies on gut microbiota and glucose homeostasis in drug-naïve patients with type 2 diabetes. Seventy drug-naïve patients with type 2 diabetes (mean age, 52.2 years) with a glycated hemoglobin (HbA1c) level ≥7.5% were assigned to either gemigliptin–metformin or glimepiride–metformin combination therapies for 24 weeks. Changes in gut microbiota, biomarkers linked to glucose regulation, body composition, and amino acid blood levels were investigated. Although both treatments decreased the HbA1c levels significantly, the gemigliptin–metformin group achieved HbA1c ≤ 7.0% without hypoglycemia or weight gain more effectively than did the glimepiride–metformin group (59% vs. 24%; <i>p</i> < 0.05). At the phylum level, the Firmicutes/Bacteroidetes ratio tended to decrease after gemigliptin–metformin therapy (<i>p</i> = 0.065), with a notable depletion of taxa belonging to Firmicutes, including <i>Lactobacillus</i>, <i>Ruminococcus torques</i>, and <i>Streptococcus</i> (all <i>p</i> < 0.05). However, regardless of the treatment modality, a distinct difference in the overall gut microbiome composition was noted between patients who reached the HbA1c target goal and those who did not (<i>p</i> < 0.001). Treatment with gemigliptin–metformin resulted in a higher achievement of the glycemic target without hypoglycemia or weight gain, better than with glimepiride–metformin; these improvements might be related to beneficial changes in gut microbiota. |
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| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-09T12:02:39Z |
| publishDate | 2023-01-01 |
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| series | Nutrients |
| spelling | doaj.art-55641122b56740d283f4ed2bb46e96862023-11-30T23:01:41ZengMDPI AGNutrients2072-66432023-01-0115124810.3390/nu15010248Effects of Initial Combinations of Gemigliptin Plus Metformin Compared with Glimepiride Plus Metformin on Gut Microbiota and Glucose Regulation in Obese Patients with Type 2 Diabetes: The INTESTINE StudySoo Lim0Minji Sohn1Jose C. Florez2Michael A. Nauck3Jiyoung Ahn4Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Republic of KoreaDepartment of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Republic of KoreaDiabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USADiabetes Division, Katholisches Klinikum Bochum, St. Josef Hospital (Ruhr University Bochum), 44791 Bochum, GermanyDepartment of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USAThe efficacy and safety of medications can be affected by alterations in gut microbiota in human beings. Among antidiabetic medications, incretin-based therapy such as dipeptidyl peptidase 4 inhibitors might affect gut microbiomes, which are related to glucose metabolism. This was a randomized, controlled, active-competitor study that aimed to compare the effects of combinations of gemigliptin–metformin vs. glimepiride–metformin as initial therapies on gut microbiota and glucose homeostasis in drug-naïve patients with type 2 diabetes. Seventy drug-naïve patients with type 2 diabetes (mean age, 52.2 years) with a glycated hemoglobin (HbA1c) level ≥7.5% were assigned to either gemigliptin–metformin or glimepiride–metformin combination therapies for 24 weeks. Changes in gut microbiota, biomarkers linked to glucose regulation, body composition, and amino acid blood levels were investigated. Although both treatments decreased the HbA1c levels significantly, the gemigliptin–metformin group achieved HbA1c ≤ 7.0% without hypoglycemia or weight gain more effectively than did the glimepiride–metformin group (59% vs. 24%; <i>p</i> < 0.05). At the phylum level, the Firmicutes/Bacteroidetes ratio tended to decrease after gemigliptin–metformin therapy (<i>p</i> = 0.065), with a notable depletion of taxa belonging to Firmicutes, including <i>Lactobacillus</i>, <i>Ruminococcus torques</i>, and <i>Streptococcus</i> (all <i>p</i> < 0.05). However, regardless of the treatment modality, a distinct difference in the overall gut microbiome composition was noted between patients who reached the HbA1c target goal and those who did not (<i>p</i> < 0.001). Treatment with gemigliptin–metformin resulted in a higher achievement of the glycemic target without hypoglycemia or weight gain, better than with glimepiride–metformin; these improvements might be related to beneficial changes in gut microbiota.https://www.mdpi.com/2072-6643/15/1/248antidiabetic drugstype 2 diabetesintestinal floradipeptidyl peptidase-4 inhibitorsulfonylurea |
| spellingShingle | Soo Lim Minji Sohn Jose C. Florez Michael A. Nauck Jiyoung Ahn Effects of Initial Combinations of Gemigliptin Plus Metformin Compared with Glimepiride Plus Metformin on Gut Microbiota and Glucose Regulation in Obese Patients with Type 2 Diabetes: The INTESTINE Study Nutrients antidiabetic drugs type 2 diabetes intestinal flora dipeptidyl peptidase-4 inhibitor sulfonylurea |
| title | Effects of Initial Combinations of Gemigliptin Plus Metformin Compared with Glimepiride Plus Metformin on Gut Microbiota and Glucose Regulation in Obese Patients with Type 2 Diabetes: The INTESTINE Study |
| title_full | Effects of Initial Combinations of Gemigliptin Plus Metformin Compared with Glimepiride Plus Metformin on Gut Microbiota and Glucose Regulation in Obese Patients with Type 2 Diabetes: The INTESTINE Study |
| title_fullStr | Effects of Initial Combinations of Gemigliptin Plus Metformin Compared with Glimepiride Plus Metformin on Gut Microbiota and Glucose Regulation in Obese Patients with Type 2 Diabetes: The INTESTINE Study |
| title_full_unstemmed | Effects of Initial Combinations of Gemigliptin Plus Metformin Compared with Glimepiride Plus Metformin on Gut Microbiota and Glucose Regulation in Obese Patients with Type 2 Diabetes: The INTESTINE Study |
| title_short | Effects of Initial Combinations of Gemigliptin Plus Metformin Compared with Glimepiride Plus Metformin on Gut Microbiota and Glucose Regulation in Obese Patients with Type 2 Diabetes: The INTESTINE Study |
| title_sort | effects of initial combinations of gemigliptin plus metformin compared with glimepiride plus metformin on gut microbiota and glucose regulation in obese patients with type 2 diabetes the intestine study |
| topic | antidiabetic drugs type 2 diabetes intestinal flora dipeptidyl peptidase-4 inhibitor sulfonylurea |
| url | https://www.mdpi.com/2072-6643/15/1/248 |
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