title: Vildagliptin vs liraglutide as a second-line therapy switched from sitagliptin-based regimens in patients with type 2 diabetes: A randomized, parallel-group study.
abstract: BACKGROUND
  A step-up strategy for dipeptidyl peptidase (DPP)-4 inhibitor-based regimens has not yet been established. In addition, similarities and differences between DPP-4 inhibitors and glucagon-like peptide (GLP)-1 receptor agonists remain to be elucidated in humans. We investigated the pleiotropic effects of vildagliptin vs liraglutide in patients with type 2 diabetes on sitagliptin-based regimens in an open-label, randomized, clinical trial.
  
  
  METHODS
  A total of 122 patients with type 2 diabetes that was inadequately controlled by sitagliptin-based regimens were randomly assigned to either vildagliptin (50 mg, twice daily) or liraglutide treatment (0.9 mg, once daily) for 12 weeks. The primary outcomes were glycated hemoglobin and body mass index.
  
  
  RESULTS
  Both vildagliptin and liraglutide significantly lowered glycated hemoglobin within 12 weeks after switching from sitagliptin, but liraglutide produced a greater reduction (-0.67 ± 0.12% vs -0.36 ± 0.53%). Liraglutide lowered body mass index, whereas vildagliptin did not affect body mass index. Vildagliptin lowered fasting C-peptide immunoreactivity, but liraglutide did not. Vildagliptin increased serum levels of adiponectin, arachidonic acid, eicosapentaenoic acid and docosahexaenoic acid, whereas liraglutide had no effect on these levels. Quality of life, assessed using the diabetes treatment satisfaction questionnaire, was not impaired in either group. The most common adverse events were gastrointestinal symptoms, which occurred with similar frequencies in both groups.
  
  
  CONCLUSIONS
  Vildagliptin-mediated improvements in glycemic control did not correlate with indices for insulin secretion and insulin sensitivity. Switching from sitagliptin to liraglutide is useful in managing hyperglycemia and weight. Each agent exerts unique pleiotropic effects. This trial was registered with the University Hospital Medical Information Network Clinical Trials Registry (no. 000004953).
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan.
authors: Yumie
authors: Y
authors: Takeshita
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan.
authors: Toshinari
authors: T
authors: Takamura
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan.
authors: Yuki
authors: Y
authors: Kita
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan.
authors: Toshiki
authors: T
authors: Otoda
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan.
authors: Ken-Ichiro
authors: K
authors: Kato
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan.
authors: Hitomi
authors: H
authors: Wakakuri
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan.
authors: Masayuki
authors: M
authors: Yamada
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan.
authors: Hirofumi
authors: H
authors: Misu
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan.
authors: Yukiko
authors: Y
authors: Matsushima
authors: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan.
authors: Shuichi
authors: S
authors: Kaneko
keywords: Dipeptidyl peptidase-4 inhibitor; Glucagon-like peptide-1 receptor agonists; Pleiotropic effects