Optimal Candidates for the Switch from Glimepiride to Sitagliptin to Reduce Hypoglycemia in Patients with Type 2 Diabetes Mellitus
- Authors
- Kim, Hyun Min; Lim, Jung Soo; Lee, Byung-Wan; Kang, Eun-Seok; Lee, Hyun Chul; Cha, Bong-Soo
- Issue Date
- Mar-2015
- Publisher
- KOREAN ENDOCRINE SOC
- Keywords
- DPP-4 inhibitors; Hypoglycemia; Diabetes mellitus; type 2
- Citation
- ENDOCRINOLOGY AND METABOLISM-ENM, v.30, no.1, pp 84 - 91
- Pages
- 8
- Journal Title
- ENDOCRINOLOGY AND METABOLISM-ENM
- Volume
- 30
- Number
- 1
- Start Page
- 84
- End Page
- 91
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/9780
- DOI
- 10.3803/EnM.2015.30.1.84
- ISSN
- 2093-596X
2093-5978
- 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 <= 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.
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