title: Dipeptidyl peptidase 4 inhibition increases myocardial glucose uptake in nonischemic cardiomyopathy.
abstract: BACKGROUND
  Glucose and fatty acids comprise the primary substrates for myocardial energy metabolism. The normal myocardium switches toward glucose metabolism in the setting of stress; the inability to affect such a switch is a fundamental mechanism behind "diabetic" or "insulin-resistant" cardiomyopathy. The purpose of this mechanistic study was to evaluate the effects of treatment with the dipeptidyl peptidase (DPP) 4 inhibitor sitagliptin on myocardial glucose uptake in patients with nonischemic cardiomyopathy.
  
  
  RESULTS
  Twelve nondiabetic subjects with nonischemic cardiomyopathy underwent metabolic testing and assessment of myocardial glucose uptake by (18)F-fluorodeoxyglucose positron-emission tomographic/computerized tomographic imaging at baseline and after 4 weeks of sitagliptin therapy. Sitagliptin therapy resulted in a significant increase in myocardial glucose uptake (19% increase; P = .04). Although most patients had at least a slight increase in glucose uptake, there was an overall bimodal response, with 6 patients ("responders") demonstrating large increases (>20%) in glucose uptake and 6 patients ("nonresponders") demonstrating <5% increases or slight decreases. Triglyceride-high-density lipoprotein ratios significantly dropped in the 6 responders compared with the 6 nonresponders (P < .02).
  
  
  CONCLUSIONS
  Therapy with the DPP-4 inhibitor sitagliptin results in increased myocardial glucose uptake in nondiabetic patients with nonischemic cardiomyopathy.
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA. witteles@stanford.edu
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Witteles
authors.forename: Khun Visith
authors.initials: KV
authors.lastname: Keu
authors.forename: Andrew
authors.initials: A
authors.lastname: Quon
authors.forename: Homa
authors.initials: H
authors.lastname: Tavana
authors.forename: Michael B
authors.initials: MB
authors.lastname: Fowler
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy / Q000378:metabolism*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D011719:Pyrazines / Q000627:therapeutic use*; D000068900:Sitagliptin Phosphate; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D014230:Triazoles / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D054873:Dipeptidyl-Peptidase IV Inhibitors; D011719:Pyrazines; D014230:Triazoles; D019788:Fluorodeoxyglucose F18; D000068900:Sitagliptin Phosphate