Use of Sitagliptin with Closed-Loop Technology to Decrease Postprandial Blood Glucose in Type 1 Diabetes

Lisa J. Underland, Jeniece Trast Ilkowitz, Ranjitha Katikaneni, Amy Dowd, Rubina A. Heptulla

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)602-610
Number of pages9
JournalJournal of diabetes science and technology
Volume11
Issue number3
DOIs
Publication statusPublished - May 1 2017

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Keywords

  • artificial pancreas
  • closed loop
  • sitagliptin
  • type 1 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Bioengineering
  • Medicine(all)
  • Biomedical Engineering

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