Optimal Candidates for the Switch from Glimepiride to Sitagliptin to Reduce Hypoglycemia in Patients with Type 2 Diabetes Mellitus.
- Author:
Hyun Min KIM
1
;
Jung Soo LIM
;
Byung Wan LEE
;
Eun Seok KANG
;
Hyun Chul LEE
;
Bong Soo CHA
Author Information
- Publication Type:Original Article
- Keywords: DPP-4 inhibitors; Hypoglycemia; Diabetes mellitus, type 2
- MeSH: Blood Glucose; Diabetes Mellitus, Type 2*; Fasting; Hemoglobin A, Glycosylated; Homeostasis; Humans; Hypoglycemia*; Insulin Resistance; Logistic Models; Metformin; Sitagliptin Phosphate
- From:Endocrinology and Metabolism 2015;30(1):84-91
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: Sitagliptin is a novel antidiabetic agent with a low risk for hypoglycemia. We investigated the efficacy and safety of sitagliptin when patients switched from a sulfonylurea to sitagliptin and identified good candidates for the switch. METHODS: Sixty-one patients with type 2 diabetes switched from glimepiride with metformin to sitagliptin with metformin due to clinical hypoglycemia. Serum glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2-hour postprandial plasma glucose (2h-PPG) before and 12 and 24 weeks after the drug switch were checked. RESULTS: HbA1c and FPG levels did not change 12 or 24 weeks after the switch; however, the 2h-PPG level decreased from 218.0+/-67.5 mg/dL at baseline to 197.1+/-69.9 mg/dL at 12 weeks and 192.3+/-67.4 mg/dL at 24 weeks after switching drugs (P=0.045, P=0.018, respectively). All but one patient no longer experienced hypoglycemia after discontinuing glimepiride. In a multivariate logistic regression analysis, a high homeostasis model assessment of insulin resistance and low baseline HbA1c level were independent predictors of an HbA1c < or =7% after switching to sitagliptin. CONCLUSION: Glycemic control was not aggravated in patients 24 weeks after the drug switch, and symptomatic hypoglycemia decreased significantly. Patients with dominant insulin resistance may be good candidates for switching from a sulfonylurea to sitagliptin to reduce hypoglycemia.
