TY - JOUR
T1 - Use of Sitagliptin with Closed-Loop Technology to Decrease Postprandial Blood Glucose in Type 1 Diabetes
AU - Underland, Lisa J.
AU - Ilkowitz, Jeniece Trast
AU - Katikaneni, Ranjitha
AU - Dowd, Amy
AU - Heptulla, Rubina A.
N1 - Publisher Copyright:
© Diabetes Technology Society.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Background: Postprandial hyperglycemia poses a challenge to closed-loop systems. Dipeptidyl peptidase-4 (DPP-4) inhibitors, like sitagliptin, reduce postprandial glucose concentrations in patients with type 2 diabetes. The objective of this study was to assess sitagliptin's role in type 1 diabetes (T1DM) as an adjunct therapy in reducing postprandial blood glucose with an insulin-only closed-loop system. Methods: This was a randomized, double-blinded, placebo controlled, crossover design trial. The participants were18-35 years old, had T1DM, and an HbA1c of ≤ 8.5%. A dose determination study included eight subjects with T1DM. There were three study visits. Four hours after receiving study drug (placebo, sitagliptin 50 mg, sitagliptin 100 mg), subjects underwent a mixed meal tolerance test with assessment of hormone concentrations. In a second study, 15 subjects underwent two visits receiving either placebo or 100 mg of sitagliptin plus an insulin only closed-loop system for 25 hours with timed meals. Blood glucose and other hormone concentrations were analyzed using repeated measures ANOVA. Results: For the dose determination study, sitagliptin 100 mg resulted in reduced postprandial blood glucose (P =.006). For the closed-loop study, glucose concentrations were lower in the treatment group, most prominently during the first two study meals (P =.03). There was no difference in glucagon concentrations, but insulin concentrations and insulin delivery were lower in the treatment group. Conclusions: Sitagliptin may be considered as an adjunct therapy in a closed-loop setting. Larger studies are needed to determine the role of oral agents like sitagliptin to lower postprandial hyperglycemia with closed loop.
AB - Background: Postprandial hyperglycemia poses a challenge to closed-loop systems. Dipeptidyl peptidase-4 (DPP-4) inhibitors, like sitagliptin, reduce postprandial glucose concentrations in patients with type 2 diabetes. The objective of this study was to assess sitagliptin's role in type 1 diabetes (T1DM) as an adjunct therapy in reducing postprandial blood glucose with an insulin-only closed-loop system. Methods: This was a randomized, double-blinded, placebo controlled, crossover design trial. The participants were18-35 years old, had T1DM, and an HbA1c of ≤ 8.5%. A dose determination study included eight subjects with T1DM. There were three study visits. Four hours after receiving study drug (placebo, sitagliptin 50 mg, sitagliptin 100 mg), subjects underwent a mixed meal tolerance test with assessment of hormone concentrations. In a second study, 15 subjects underwent two visits receiving either placebo or 100 mg of sitagliptin plus an insulin only closed-loop system for 25 hours with timed meals. Blood glucose and other hormone concentrations were analyzed using repeated measures ANOVA. Results: For the dose determination study, sitagliptin 100 mg resulted in reduced postprandial blood glucose (P =.006). For the closed-loop study, glucose concentrations were lower in the treatment group, most prominently during the first two study meals (P =.03). There was no difference in glucagon concentrations, but insulin concentrations and insulin delivery were lower in the treatment group. Conclusions: Sitagliptin may be considered as an adjunct therapy in a closed-loop setting. Larger studies are needed to determine the role of oral agents like sitagliptin to lower postprandial hyperglycemia with closed loop.
KW - artificial pancreas
KW - closed loop
KW - sitagliptin
KW - type 1 diabetes
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U2 - 10.1177/1932296817699847
DO - 10.1177/1932296817699847
M3 - Article
C2 - 28349708
AN - SCOPUS:85018995962
SN - 1932-2968
VL - 11
SP - 602
EP - 610
JO - Journal of Diabetes Science and Technology
JF - Journal of Diabetes Science and Technology
IS - 3
ER -