title: The dipeptidyl peptidase-4 (DPP-4) inhibitor vildagliptin improves glycemic control in type 2 diabetic patients undergoing hemodialysis.
abstract: The potent and selective dipeptidyl peptidase-4 inhibitor vildagliptin improves glycemic control in patients with type 2 diabetes through incretin hormone-mediated increases in both α- and β-cell responsiveness to glucose.  We conducted a prospective, open-label, parallel group, controlled study of 51 patients with type 2 diabetic patients undergoing hemodialysis (HD) during the 24-week study period.  Patients were assigned to two groups: the vildagliptin group (n = 30) and the control group (n = 21).  Vildagliptin was administered at 50 mg/day for the first 8 weeks.  Then doses were titrated by dose-doubling to a maximum of 100 mg/day if hemoglobin A1c (HbA1c) or glycated albumin (GA) target levels had not been reached.  No vildagliptin was administered to the controls.  The average final dose of vildagliptin was 80 ± 5 mg daily.  After 24 weeks, vildagliptin had decreased average HbA1c levels from 6.7 % baseline to 6.1 %, average GA levels from 24.5 % baseline to 20.5 % and average postprandial plasma glucose levels from 186 mg/dL baseline to 140 mg/dL (all p < 0.0001).  In the control group, we observed no such changes.  Vildagliptin efficacy did not differ according to age or body mass index, but the GA reduction was significantly greater in the anti-diabetic agents-naïve group.  Furthermore, in patients with higher baseline GA levels, a higher vildagliptin dosage was required to produce a noticeable effect.  No serious adverse effects such as hypoglycemia or liver impairment were observed in any patient.  Vildagliptin was effective as a treatment for diabetic patients undergoing HD.
authors.affiliation: Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Midori
authors.initials: M
authors.lastname: Ito
authors.forename: Masanori
authors.initials: M
authors.lastname: Abe
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Okada
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Sasaki
authors.forename: Noriaki
authors.initials: N
authors.lastname: Maruyama
authors.forename: Masaaki
authors.initials: M
authors.lastname: Tsuchida
authors.forename: Terumi
authors.initials: T
authors.lastname: Higuchi
authors.forename: Fumito
authors.initials: F
authors.lastname: Kikuchi
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Soma
mesh_terms: D000218:Adamantane / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009570:Nitriles / Q000627:therapeutic use*; D011446:Prospective Studies; D011759:Pyrrolidines / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000379:methods*; D018709:Statistics, Nonparametric; D000077597:Vildagliptin
chemical_list: D000218:Adamantane; D001786:Blood Glucose; D054873:Dipeptidyl-Peptidase IV Inhibitors; D006442:Glycated Hemoglobin; D009570:Nitriles; D011759:Pyrrolidines; D000077597:Vildagliptin