Initial combination therapy with DPP-IV inhibitors more effectively reduced MAGE than stepwise add-on therapies ( p = 0.006 ) , although no differences in MAGE were found based on HbA1c values .
These findings indicate that DPP-IV inhibitors are promising alternatives for reducing GV in type 2 diabetes patients .
Glycemic variability ( GV ) has been an emerging target for preventing complications related to type 2 diabetes .
For reducing GV , DPP-IV inhibitors have shown effectiveness compared to other oral anti-hyperglycemic drugs ( OADs ) , but systematic evaluation has yet to be existed .
Reduction of Oxidative Stress and Inflammation by Blunting Daily Acute Glucose Fluctuations in Patients With Type 2 Diabetes
OBJECTIVE Evaluate the effects of two dipeptidyl peptidase-IV ( DPP-4 ) inhibitors , sitagliptin and vildagliptin , known to have different efficacy on mean amplitude of glycemic excursions ( MAGE ) , on oxidative stress , and on systemic inflammatory markers in patients with type 2 diabetes . RESEARCH DESIGN AND METHODS A prospect i ve , r and omized , open-label PROBE design ( parallel group with a blinded end point ) study was performed in 90 patients with type 2 diabetes inadequately controlled by metformin . The study assigned 45 patients to receive sitagliptin ( 100 mg once daily ; sitagliptin group ) and 45 patients to receive vildagliptin ( 50 mg twice daily ; vildagliptin group ) for 12 weeks . MAGE , evaluated during 48 h of continuous subcutaneous glucose monitoring , allowed an assessment of daily glucose fluctuations at baseline and after 12 weeks in all patients . Assessment of oxidative stress ( nitrotyrosine ) and systemic levels of inflammatory markers interleukin (IL)-6 and IL-18 was performed at baseline and after 12 weeks in all patients . RESULTS HbA1c , fasting and postpr and ial glucose , MAGE , and inflammatory and oxidative stress markers were similar between the groups at baseline . After 12 weeks , MAGE ( P < 0.01 ) was lower in the vildagliptin group than in the sitagliptin group . After treatment , HbA1c and postpr and ial glucose evidence d similar changes between the groups ( P = NS ) . Vildagliptin treatment was associated with a stronger decrease in nitrotyrosine ( P < 0.01 ) , IL-6 ( P < 0.05 ) , and IL-18 ( P < 0.05 ) than sitagliptin treatment . Nitrotyrosine and IL-6 changes significantly correlated with changes in MAGE but not in fasting glucose and HbA1c . CONCLUSIONS MAGE reduction is associated with reduction of oxidative stress and markers of systemic inflammation in type 2 diabetic patients . These effects were greater in the vildagliptin group than in the sitagliptin group
Initial combination therapy with DPP-IV inhibitors more effectively reduced MAGE than stepwise add-on therapies ( p = 0.006 ) , although no differences in MAGE were found based on HbA1c values .
These findings indicate that DPP-IV inhibitors are promising alternatives for reducing GV in type 2 diabetes patients .
Glycemic variability ( GV ) has been an emerging target for preventing complications related to type 2 diabetes .
For reducing GV , DPP-IV inhibitors have shown effectiveness compared to other oral anti-hyperglycemic drugs ( OADs ) , but systematic evaluation has yet to be existed .