Vildagliptin improves glycemic control in type 2 diabetes patients undergoing hemodialysis

Abstract

[Background and objectives] Since the dipeptidyl peptidase-4 (DPP-4) inhibitor, a therapeutic agent for diabetes mellitus involving incretin, emerged, it has brought about a paradigm shift in the treatment of diabetes mellitus. Among DPP-4 inhibitors, vildagliptin is available not only for patients with renal insufficiency, but also for hemodialysis patients. The purpose of this study was to assess the efficacy and safety of vildagliptin (50 mg once daily), and observe the effect on glucose fluctuations using continuous glucose monitoring (CGM) in hemodialysis patients with type 2 diabetes mellitus (T2DM). [Design, setting, participants, & measurements] The study included 42 hemodialysis patients (26 men: mean age±SD, 68.0±11.2 years) with T2DM who had inadequate glycemic control. We divided them into two groups. Fifty mg/day of vildagliptin was administered to one group (V group) in addition to the original treatment. The other group (C group) continued the original treatment. We assessed HbA1c, glycated albumin (GA), and blood glucose values in the two groups before and 1 month after the treatment. Additionally, we evaluated the averaged glucose value (AGV) and blood glucose fluctuation (SD) for 24 hours using continuous glucose monitoring (CGM). [Results] In the V group, HbA1c and the blood glucose value decreased significantly 1 month after the administration of vildagliptin (6.5±1.1 to 5.6±1.1% and 184±79 to 135±50 mg/dL, p<0.05, respectively). GA also showed improvement in the V group (25.1±5.3 to 22.9±4.4%, p=0.16). CGM showed that AGV and SD improved both one day and one month after vildagliptin administration. [Conclusion] Our data showed that vildagliptin improved blood glucose control rapidly as well as glycemic fluctuations without any adverse effects.