title: The metabolic syndrome influences the response to incretin-based therapies.
abstract: We hypothesize that type 2 diabetic patients with different phenotypes may show different response to incretin-based therapies. Therefore, we tested whether the presence of metabolic syndrome (MS) influences glycemic response to these drugs. We prospectively followed 211 patients, treated with the GLP-1 analog exenatide (n = 102) or a DPP-4 inhibitor (n = 109) for at least 4 months. Treatment was decided on clinical grounds. We collected baseline data (age, sex, BMI, waist, systolic and diastolic blood pressure, lipid profile, data on diabetic complications and concomitant treatment) and HbA1c at subsequent visits. Patients were divided into groups according to the presence/absence of MS. Compared to patients on exenatide, patients on DPP-4 inhibitors were older and had lower BMI, waist, diastolic blood pressure, fasting plasma glucose, and HbA1c. At means of baseline values, HbA1c reduction was similar in patients treated with exenatide or DPP-4 inhibitors. Patients on exenatide showed significantly higher HbA1c reduction if they had MS (-1.55 ± 0.22%; n = 88) than if they had not (-0.34 ± 0.18%; P = 0.002). Conversely, patients on DPP-4 inhibitors showed significantly lower HbA1c reduction if they had MS (-0.60 ± 0.12%; n = 73) than if they had not (-1.50 ± 0.24%; P < 0.001). Type of MS definition (ATP-III, IDF or WHO) poorly influenced these trends. The interaction between type of therapy (exenatide vs. DPP-4 inhibitors) and MS remained significant after adjusting for age, baseline HbA1c, BMI, and concomitant medications. In conclusion, the presence of MS appears to modify the response to incretin-based therapies. Given the non-randomized nature of this study, these data need to be replicated.
authors.affiliation: Department of Clinical and Experimental Medicine, Chair and Division of Metabolic Diseases, University of Padova, Medical School, Italy. gianpaolo.fadini@unipd.it
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Fadini
authors.forename: Saula Vigili
authors.initials: SV
authors.lastname: de Kreutzenberg
authors.forename: Romelda
authors.initials: R
authors.lastname: Gjini
authors.forename: Angelo
authors.initials: A
authors.lastname: Avogaro
mesh_terms: D000218:Adamantane / Q000031:analogs & derivatives / Q000627:therapeutic use; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000534:rehabilitation; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use; D000077270:Exenatide; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000031:analogs & derivatives; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D054795:Incretins / Q000627:therapeutic use*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D009570:Nitriles / Q000627:therapeutic use; D010455:Peptides / Q000627:therapeutic use; D011379:Prognosis; D011719:Pyrazines / Q000627:therapeutic use; D011759:Pyrrolidines / Q000627:therapeutic use; D000068900:Sitagliptin Phosphate; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use; D014688:Venoms / Q000627:therapeutic use; D000077597:Vildagliptin
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D054795:Incretins; D009570:Nitriles; D010455:Peptides; D011719:Pyrazines; D011759:Pyrrolidines; D014230:Triazoles; D014688:Venoms; D052216:Glucagon-Like Peptide 1; D000077270:Exenatide; D000077597:Vildagliptin; D000218:Adamantane; D000068900:Sitagliptin Phosphate