natgillin/translations-raw huggingface dataset:
Incretin hormones, including glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), are released by the intestine throughout the day, and levels are increased in response to a meal.
Hormonii endogeni, care includ peptidul 1 glucagon- like (PGL- 1) i polipeptidul insulinotrop dependent de glucoz (PIG), sunt elibera i din intestin pe tot parcursul zilei, iar concentra iile lor cresc ca r spuns la ingestia de alimente.
The incretins are part of an endogenous system involved in the physiologic regulation of glucose homeostasis.
Ace ti hormoni fac parte dintr- un sistem endogen implicat în reglarea fiziologic a homeostaziei glucozei.
When blood glucose concentrations are normal or elevated, GLP-1 and GIP increase insulin synthesis and release from pancreatic beta cells by intracellular signaling pathways involving cyclic AMP.
Când concentra iile glucozei în sânge sunt normale sau crescute, PGL- 1 i PIG cresc sinteza i eliberarea insulinei din celulele beta pancreatice, prin c i de semnalizare intracelular
Treatment with GLP-1 or with DPP-4 inhibitors in animal models of type 2 diabetes has been demonstrated to improve beta cell responsiveness to glucose and stimulate insulin biosynthesis and release.
Tratamentul cu PGL- 1 sau cu inhibitori ai DPP- 4 pe modele animale de diabet zaharat tip 2 a demonstrat îmbun t irea r spunsului celulelor beta la glucoz i stimularea biosintezei i eliber rii insulinei.
With higher insulin levels, tissue glucose uptake is enhanced.
În cazul unor concentra ii mai mari de insulin, preluarea glucozei în esuturi este crescut.
In addition, GLP-1 lowers glucagon secretion from pancreatic alpha cells.
În plus, PGL- 1 reduce secre ia de glucagon din celulele alfa pancreatice.
Decreased glucagon concentrations, along with higher insulin levels, lead to reduced hepatic glucose production, resulting in a decrease in blood glucose levels.
Concentra iile reduse de glucagon, împreun cu concentra iile mai mari de insulin, duc la o produc ie hepatic mai redus de glucoz, determinând sc derea glicemiei.
The effects of GLP-1 and GIP are glucose-dependent such that when blood glucose concentrations are low, stimulation of insulin release and suppression of glucagon secretion by GLP-1 are not observed.
Efectele PGL- 1 i PIG sunt dependente de glucoz, astfel încât atunci când concentra iile glucozei în sânge sunt mici nu se observ stimularea eliber rii de insulin i supresia secre iei de glucagon de c tre PGL- 1.
For both GLP-1 and GIP, stimulation of insulin release is enhanced as glucose rises above normal concentrations.
Atât pentru PGL- 1 cât i pentru PIG, stimularea eliber rii de insulin este intensificat atunci când glucoza cre te peste concentra iile normale.
Further, GLP-1 does not impair the normal glucagon response to hypoglycaemia.
În plus, PGL- 1 nu afecteaz r spunsul normal al glucagonului la hipoglicemie.
The activity of GLP-1 and GIP is limited by the DPP-4 enzyme, which rapidly hydrolyzes the incretin hormones to produce inactive products.
Activitatea PGL- 1 i PIG este limitat de enzima DPP- 4, care hidrolizeaz rapid hormonii endogeni în metaboli i inactivi.
Sitagliptin prevents the hydrolysis of incretin hormones by DPP-4, thereby increasing plasma concentrations of the active forms of GLP-1 and GIP.
Sitagliptin împiedic hidroliza hormonilor endogeni de c tre DPP- 4, crescând astfel concentra iile plasmatice ale formelor active de PGL- 1 i PIG.
By enhancing active incretin levels, sitagliptin increases insulin release and decreases glucagon levels in a glucose- dependent manner.
Prin cre terea valorilor hormonilor endogeni activi, sitagliptin cre te eliberarea de insulin i scade valorile de glucagon, într- un mod dependent de glucoz.
In patients with type 2 diabetes with hyperglycaemia, these changes in insulin and glucagon levels lead to lower hemoglobin A1c (HbA1c) and lower fasting and postprandial glucose concentrations.
La pacien ii cu diabet zaharat tip 2 cu hiperglicemie, aceste modific ri ale valorilor insulinei i glucagonului determin sc derea hemoglobinei A1c (HbA1c) i sc derea glicemiei á jeun i postprandiale.
The glucose-dependent mechanism of sitagliptin is distinct from the mechanism of sulphonylureas, which increase insulin secretion even when glucose levels are low and can lead to hypoglycaemia in patients with type 2 diabetes and in normal subjects.
Mecanismul dependent de glucoz al sitagliptinului este diferit de mecanismul sulfonilureei, care cre te secre ia de insulin chiar dac valorile glucozei sunt mici i poate determina hipoglicemie la pacien ii cu diabet zaharat tip 2 i la subiec ii normali.
Sitagliptin is a potent and highly selective inhibitor of the enzyme DPP-4 and does not inhibit the closely-related enzymes DPP-8 or DPP-9 at therapeutic concentrations.
Sitagliptin este un inhibitor potent i selectiv al enzimei DPP- 4 iar la concentra ii terapeutice nu inhib enzimele înrudite DPP- 8 sau DPP- 9.
7 Overall, sitagliptin improved glycaemic control when given as monotherapy, when used in combination with metformin (initial or add-on therapy), in combination with a sulphonylurea (with or without metformin), and in combination with a thiazolidinedione, as measured by clinically relevant reductions in HbA1c from baseline at study endpoint (see Table 2).
Per global, sitagliptinul a îmbun t it controlul glicemic atunci când s- a folosit în monoterapie, în asociere cu metforminul (ini ial sau ca terapie suplimentar), în asociere cu o sulfoniluree (cu sau f r metformin) i în asociere cu o tiazolidindion, fapt dovedit prin reducerea relevant clinic a HbA1c de la momentul ini ial la momentul final al studiului (vezi tabelul 2).
Two studies were conducted to evaluate the efficacy and safety of TESAVEL monotherapy.
Pentru evaluarea eficacit ii i siguran ei monoterapiei cu TESAVEL au fost efectuate dou studii.
Treatment with sitagliptin at 100 mg once daily as monotherapy provided significant improvements in HbA1c, fasting plasma glucose (FPG), and 2-hour post-prandial glucose (2-hour PPG), compared to placebo in two studies, one of 18- and one of 24-weeks duration.
Tratamentul cu sitagliptin în doz de 100 mg administrat o dat pe zi în monoterapie a fost asociat cu amelior ri semnificative, comparativ cu placebo, ale valorilor HbA1c, ale glicemiei á jeun (GJ) i ale glicemiei determinate la 2 ore postprandial (GPP la 2 ore) în cadrul a dou studii clinice, unul cu durat de 18 s pt mâni i cel lalt cu durat de 24 s pt mâni.
Improvement of surrogate markers of beta cell function, including HOMA-β (Homeostasis Model Assessment-β), proinsulin to insulin ratio, and measures of beta cell responsiveness from the frequently-sampled meal tolerance test were observed.
S- a observat îmbun t irea semnificativ a markerilor surogat ai func iei celulelor beta, inclusiv HOMA - (Homeostasis Model Assessment - – Modelul de evaluare a homeostaziei), raportul proinsulin - insulin i parametrii de responsivitate a celulelor beta, din cadrul testului de toleran la glucoz cu determin ri frecvente.
The observed incidence of hypoglycaemia in patients treated with TESAVEL was similar to placebo.
Inciden a observat a hipoglicemiei la pacien ii trata i cu TESAVEL a fost similar cu placebo.
Body weight did not increase from baseline with sitagliptin therapy in either study, compared to a small reduction in patients given placebo.
În cursul terapiei cu sitagliptin, greutatea corporal nu a crescut fa de cea ini ial în nici unul dintre studii, comparativ cu o u oar sc dere înregistrat la pacien ii c rora li s- a administrat placebo.
In a study in patients with type 2 diabetes and chronic renal insufficiency (creatinine clearance < 50 ml/ min), the safety and tolerability of reduced doses of sitagliptin were investigated and generally similar to placebo.
Într- un studiu care a inclus pacien i cu diabet zaharat tip 2 i cu insuficien renal cronic (clearance - ul creatininei < 50 ml/ min), au fost studiate siguran a i tolerabilitatea dozelor reduse de sitagliptin i acestea au fost, în general, similare cu placebo.
The number of patients with moderate to severe renal insufficiency was too low to confirm safe use of sitagliptin in this type of patients.
Num rul pacien ilor cu insuficien renal moderat pân la sever a fost prea mic pentru a confirma siguran a utiliz rii sitagliptin la acest grup de pacien i.
Sitagliptin 100 mg once daily provided significant improvements in glycaemic parameters compared with placebo in two 24-week studies of sitagliptin as add-on therapy, one in combination with metformin and one in combination with pioglitazone.
În cadrul a dou studii clinice cu durat de 24 s pt mâni în care sitagliptinul a fost utilizat ca terapie ad ugat, într- unul în asociere cu metformin i în cel lalt în asociere cu pioglitazon, sitagliptinul în doz de 100 mg o dat pe zi a determinat îmbun t iri semnificative ale parametrilor glicemici în compara ie cu placebo.
Change from baseline in body weight was similar for patients treated with sitagliptin relative to placebo.
Modificarea greut ii corporale fa de momentul ini ial a fost similar la pacien ii trata i cu sitagliptin comparativ cu placebo.
In these studies there was a similar incidence of hypoglycaemia reported for patients treated with sitagliptin or placebo.
În aceste studii, inciden a hipoglicemiei raportate a fost similar la pacien ii trata i cu sitagliptin, comparativ cu placebo.
A 24-week placebo-controlled study was designed to evaluate the efficacy and safety of sitagliptin (100 mg once daily) added to glimepiride alone or glimepiride in combination with metformin.
Un studiu clinic cu durata de 24 s pt mâni controlat cu placebo a fost conceput s evalueze eficacitatea i siguran a administr rii sitagliptinului (100 mg o dat pe zi) ad ugat la glimepirid în
The addition of sitagliptin to either glimepiride alone or to glimepiride and metformin provided significant improvements in glycaemic parameters.
Ad ugarea sitagliptinului fie la glimepirid în monoterapie, fie la glimepirid i metformin a determinat îmbun t iri semnificative ale parametrilor glicemici.
Patients treated with sitagliptin had a modest increase in body weight compared to those given placebo.
Pacien ii trata i cu sitagliptin au prezentat o cre tere modest a greut ii corporale comparativ cu cei c rora li s- a administrat placebo.
In a 24-week placebo-controlled factorial study of initial therapy, sitagliptin 50 mg twice daily in combination with metformin (500 mg or 1000 mg twice daily) provided significant improvements in glycaemic parameters compared with either monotherapy.
Într- un studiu clinic cu design factorial cu durata de 24 s pt mâni, controlat cu placebo, administrarea ini ial de sitagliptin 50 mg de dou ori pe zi în asociere cu metformin (500 mg sau 1000 mg de dou ori pe zi) a determinat îmbun t iri semnificative ale valorilor parametrilor glicemici, comparativ cu fiecare administrare a acestora în monoterapie.
The decrease in body weight with the combination of sitagliptin and metformin was similar to that observed with metformin alone or placebo; there was no change from baseline for patients on sitagliptin alone.
Sc derea greut ii corporale în cazul administr rii sitagliptinului în asociere cu metformin a fost similar cu cea observat la administrarea metforminului în monoterapie sau la administrarea placebo; la pacien ii c rora li s- a administrat sitagliptin în monoterapie nu s- a înregistrat nicio modificare fa de valoarea ini ial.
The incidence of hypoglycaemia was similar across treatment groups.
Inciden a hipoglicemiei în cadrul grupurilor de tratament a fost similar.
HbA1c results in placebo-controlled monotherapy and combination therapy studies*
Rezultatele HbA1c în urma monoterapiei i terapiei asociate în studii clinice controlate cu placebo *
change in HbA1c (%) at
Modificarea medie cu Modificarea medie corec ie placebo a Valoarea fa de momentul HbA1c (%) la
baseline HbA1c (%)
medie ini ial HbA1c (%)
baseline HbA1c (%) † at Week 24
ini ial a HbA1c (%) la s pt mâna 24 †
Week 24† (95% CI)
s pt mâna 24 † (IÎ 95%)
Monotherapy Studies Sitagliptin 100 mg once daily§
Studii cu monoterapie Sitagliptin 100 mg o dat pe zi§
(N= 193) Sitagliptin 100 mg once daily (N= 229) Combination Therapy Studies Sitagliptin 100 mg once daily added to
(n= 229) Studii cu terapie asociat Sitagliptin 100 mg o dat pe zi ad ugat la terapie neîntrerupt cu
Placebo-corrected mean
metformin (n=453) Sitagliptin 100 mg o dat pe zi ad ugat la terapie neîntrerupt cu
Sitagliptin 100 mg once daily added to -0.7‡ ongoing pioglitazone therapy (N=163) Sitagliptin 100 mg once daily added to
pioglitazon (n=163) Sitagliptin 100 mg o dat pe zi ad ugat la terapie neîntrerupt cu
ongoing glimepiride therapy (N=102) Sitagliptin 100 mg once daily added to
glimepirid (n=102) Sitagliptin 100 mg o dat pe zi ad ugat la terapie neîntrerupt cu
ongoing glimepiride + metformin therapy (N=115) Initial therapy (twice daily):
glimepirid + metformin (n=115) Terapie ini ial (de dou ori pe zi): sitagliptin 50 mg + metformin 500
Sitagliptin 50 mg + metformin 500 mg (N=183) Initial therapy (twice daily):
mg (n=183) Terapie ini ial (de dou ori pe zi): sitagliptin 50 mg + metformin
* All Patients Treated Population (an intention-to-treat analysis). † Least squares means adjusted for prior antihyperglycaemic therapy status and baseline value. ‡ p < 0.001 compared to placebo or placebo + combination treatment. § HbA1c (%) at week 18.
9 † media celor mai mici p trate ajustat pentru statusul anterior terapiei antihiperglicemice i valorii ini iale. ‡ p < 0, 001 comparativ cu placebo sau cu tratamentul placebo + asociere. § HbA1c (%) la s pt mâna 18.
In a study comparing the efficacy and safety of the addition of TESAVEL 100 mg once daily or glipizide (a sulphonylurea agent) in patients with inadequate glycaemic control on metformin monotherapy, sitagliptin was similar to glipizide in reducing HbA1c.
Într- un studiu care a comparat eficacitatea i siguran a asocierii Januvia 100 mg administrat o dat pe zi sau glipizid (un derivat de sulfoniluree) la pacien ii cu control glicemic inadecvat sub monoterapia cu metformin, sitagliptin a fost similar glipizidei în reducerea HbA1c.
The mean glipizide dose used in the comparator group was 10 mg per day with approximately 40% of patients requiring a glipizide dose of ≤ 5 mg/ day throughout the study.
Doza medie de glipizid utilizat în grupul comparator a fost de 10 mg pe zi cu aproximativ 40% dintre pacien i necesitând o doz de glipizid ≤ 5 mg pe zi de- a lungul studiului.
However, more patients in the sitagliptin group discontinued due to lack of efficacy than in the glipizide group.
Cu toate acestea, mai mul i pacien i din grupul tratat cu sitagliptin au întrerupt tratamentul datorit lipsei eficacit ii fa de grupul tratat cu glipizid.
Patients treated with sitagliptin exhibited a significant mean decrease from baseline in body weight compared to a significant weight gain in patients administered glipizide (-1.5 vs. +1.1 kg).
Pacien ii care au fost trata i cu sitagliptin au prezentat o reducere medie semnificativ a greut ii corporale comparativ cu o cre tere semnificativ în greutate a pacien ilor c rora li s- a administrat glipizid (- 1, 5 comparativ cu +1, 1 kg).
In this study, the proinsulin to insulin ratio, a marker of efficiency of insulin synthesis and release, improved with sitagliptin and deteriorated with glipizide treatment.
În acest studiu, rata proinsulin / insulin, marker- ul sintezei i eliber rii insulinei, a fost îmbun t it cu sitagliptin i deteriorat în tratamentul cu glipizid.
The incidence of hypoglycaemia in the sitagliptin group (4.9%) was significantly lower than that in the glipizide group (32.0%).
Inciden a hipoglicemiei în grupul tratat cu sitagliptin (4, 9%) a fost semnificativ mai mic decât în grupul tratat cu glipizid (32, 0%).
Absorption Following oral administration of a 100-mg dose to healthy subjects, sitagliptin was rapidly absorbed, with peak plasma concentrations (median Tmax) occurring 1 to 4 hours post-dose, mean plasma AUC of sitagliptin was 8.52 μ M• hr, Cmax was 950 nM.
Absorb ie Dup administrarea oral a unei doze de 100 mg la subiec i s n to i, sitagliptin a fost rapid absorbit, cu concentra iile plasmatice maxime (Tmax median) înregistrate la 1- 4 ore dup administrarea dozei, ASC plasmatic mediu de sitagliptin a fost de 8, 52 µM• or, iar Cmax a fost de 950 nM.
The absolute bioavailability of sitagliptin is approximately 87%.
Biodisponibilitatea absolut a sitagliptin este de aproximativ 87%.
Since coadministration of a high-fat meal with TESAVEL had no effect on the pharmacokinetics, TESAVEL may be administered with or without food.
Deoarece administrarea concomitent cu TESAVEL a unei mese bogate în lipide nu are nici un efect asupra parametrilor farmacocinetici, TESAVEL poate fi administrat cu sau f r alimente.
Plasma AUC of sitagliptin increased in a dose-proportional manner.
ASC plasmatic de sitagliptin a crescut propor ional cu doza.
Dose-proportionality was not established for Cmax and C24hr (Cmax increased in a greater than dose-proportional manner and C24hr increased in a less than dose-proportional manner).
Rela ia de propor ionalitate cu doza nu s- a stabilit pentru Cmax i C24hr (Cmax a crescut mai mult decât propor ional cu doza, iar C24hr a sc zut mai pu in decât propor ional cu doza).
Distribution The mean volume of distribution at steady state following a single 100-mg intravenous dose of sitagliptin to healthy subjects is approximately 198 liters.
Distribu ie Volumul mediu de distribu ie la starea de echilibru, dup administrarea intravenoas a unei doze unice de 100 mg sitagliptin la subiec i s n to i, este de 198 litri.
The fraction of sitagliptin reversibly bound to plasma proteins is low (38%).
Frac ia de sitagliptin care se leag în mod reversibil de proteinele plasmatice este mic (38%).
9 Metabolism Sitagliptin is primarily eliminated unchanged in urine, and metabolism is a minor pathway.
Metabolizare Sitagliptin se elimin în principal nemodificat prin urin, iar metabolizarea este minor.
Approximately 79% of sitagliptin is excreted unchanged in the urine.
Aproximativ 79% din doza de sitagliptin se elimin sub form nemodificat prin urin.
Following a [14C]sitagliptin oral dose, approximately 16% of the radioactivity was excreted as metabolites of sitagliptin.
Dup administrarea oral a unei doze de sitagliptin marcat cu [14C], aproximativ 16% din radioactivitate a fost excretat ca metaboli i ai sitagliptin.
Six metabolites were detected at trace levels and are not expected to contribute to the plasma DPP-4 inhibitory activity of sitagliptin.
Au fost detecta i ase metaboli i, în concentra ii foarte mici, i nu este de a teptat ca ace tia s contribuie la activitatea inhibitorie a DPP- 4 plasmatic manifestat de sitagliptin.
In vitro studies indicated that the primary enzyme responsible for the limited metabolism of sitagliptin was CYP3A4, with contribution from CYP2C8.
Studiile in vitro au indicat faptul c principala enzim responsabil de metabolizarea limitat a sitagliptin este CYP3A4, cu o contribu ie a CYP2C8.
In vitro data showed that sitagliptin is not an inhibitor of CYP isozymes CYP3A4, 2C8, 2C9, 2D6, 1A2, 2C19 or 2B6, and is not an inducer of CYP3A4 and CYP1A2.
Datele au ar tat c in vitro, sitagliptin nu este un inhibitor al izoenzimelor citocromului P, CYP3A4, 2C8, 2C9, 2D6, 1A2, 2C19 sau 2B6 i nu este un inductor al CYP3A4 sau CYP1A2.
Elimination Following administration of an oral [14C]sitagliptin dose to healthy subjects, approximately 100% of the administered radioactivity was eliminated in faeces (13%) or urine (87%) within one week of dosing.
Eliminare Dup administrarea la subiec i s n to i a unei doze orale de sitagliptin marcat cu [14C], aproximativ 100% din radioactivitatea administrat a fost eliminat prin materiile fecale (13%) sau urin (87%), în interval de o s pt mân de la administrarea dozei.
The apparent terminal t1/ 2 following a 100-mg oral dose of sitagliptin was approximately 12.4 hours.
T1/ 2 aparent prin eliminare, dup administrarea oral a unei doze de 100 mg sitagliptin, a fost de aproximativ 12, 4 ore.
Sitagliptin accumulates only minimally with multiple doses.
Acumularea sitagliptin dup administrarea de doze repetate este minim.
Elimination of sitagliptin occurs primarily via renal excretion and involves active tubular secretion.
10 Eliminarea sitagliptin se produce în principal prin excre ie renal i implic mecanismul de secre ie tubular activ.
Sitagliptin is a substrate for human organic anion transporter-3 (hOAT-3), which may be involved in the renal elimination of sitagliptin.
Sitagliptin este un substrat al transportorului anionic organic uman 3 (human organic anion transporter- 3 – hOAT- 3), care ar putea fi implicat în eliminarea renal a sitagliptin.
The clinical relevance of hOAT-3 in sitagliptin transport has not been established.
Relevan a clinic a hOAT- 3 în transportul sitagliptin nu a fost înc stabilit.
Sitagliptin is also a substrate of p-glycoprotein, which may also be involved in mediating the renal elimination of sitagliptin.
Sitagliptin este, de asemenea, un substrat al glicoproteinei p, care ar putea fi implicat, de asemenea, în medierea elimin rii renale a sitagliptin.
In vitro, sitagliptin did not inhibit OAT3 (IC50=160 μ M) or p-glycoprotein (up to 250 μ M) mediated transport at therapeutically relevant plasma concentrations.
In vitro, sitagliptin nu inhib OAT3 (IC50=160 µM) sau transportul mediat de glicoproteina p (pân la 250 µM), la concentra ii plasmatice terapeutice relevante.
In a clinical study sitagliptin had a small effect on plasma digoxin concentrations indicating that sitagliptin may be a mild inhibitor of p-glycoprotein.
Într- un studiu clinic sitagliptin a avut un efect mic asupra concentra iilor plasmatice de digoxin indicând faptul c sitagliptin poate fi un inhibitor u or al glicoproteinei p.
Characteristics in patients The pharmacokinetics of sitagliptin were generally similar in healthy subjects and in patients with type 2 diabetes.
Propriet i la grupurile speciale de pacien i Parametrii farmacocinetici ai sitagliptin la pacien ii cu diabet zaharat tip 2 sunt, în general, similari celor înregistra i la subiec ii s n to i.
Renal insufficiency A single-dose, open-label study was conducted to evaluate the pharmacokinetics of a reduced dose of sitagliptin (50-mg) in patients with varying degrees of chronic renal insufficiency compared to normal healthy control subjects.
Insuficien renal A fost efectuat un studiu deschis, cu doze unice, pentru evaluarea farmacocineticii unei doze reduse de sitagliptin (50 mg) la pacien i cu diverse grade de insuficien renal cronic, comparativ cu subiec i normali s n to i – lot de control.
The study included patients with renal insufficiency classified on the basis of creatinine clearance as mild (50 to < 80 ml/ min), moderate (30 to < 50 ml/ min), and severe (< 30 ml/ min), as well as patients with end-stage renal disease (ESRD) on hemodialysis.
Studiul a inclus pacien i cu insuficien renal, clasificat pe baza clearance- ului creatininei ca u oar (50 - la < 80 ml/ min), moderat (30 - < 50 ml/ min) i sever (< 30 ml/ min), ca i pacien i cu insuficien renal în stadii terminale (IRST) în program de hemodializ.
Patients with mild renal insufficiency did not have a clinically meaningful increase in the plasma concentration of sitagliptin as compared to normal healthy control subjects.
Pacien ii cu insuficien renal u oar nu au prezentat cre teri clinic semnificative ale concentra iilor plasmatice de sitagliptin, comparativ cu subiec ii normali s n to i – lot de control.
An approximately 2-fold increase in the plasma AUC of sitagliptin was observed in patients with moderate renal insufficiency, and an approximately 4-fold increase was observed in patients with severe renal insufficiency and in patients with ESRD on hemodialysis, as compared to normal healthy control subjects.
La pacien ii cu insuficien renal moderat a fost observat o cre tere de aproximativ 2 ori a ASC plasmatice de sitagliptin, iar la pacien ii cu insuficien renal sever i la cei cu IRST în program de hemodializ o cre tere de aproximativ 4 ori, comparativ cu subiec ii normali s n to i – lot de control.