title: [Clinical observation on the combined therapy of sitagliptin with insulin for patients with brittle diabetes].
abstract: OBJECTIVE
  To observe the clinical efficacy of sitagliptin plus insulin on patients with brittle diabetes and to determine the effect of the combined therapy on glucagon secretion.
  
  
  METHODS
  This randomized, double-blinded and placebo-controlled trial included 30 patients with brittle diabetes. Participants were randomly assigned (1:1) to receive the treatment of either sitagliptin plus insulin or placebo plus insulin for 12 weeks. The blood glucose, hemoglobin A1c, insulin dose, C-peptide, glucagon, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP) and other parameters were determined.
  
  
  RESULTS
  After 12 weeks of treatment, blood glucose was controlled better by sitagliptin plus insulin (P<0.01). The patients had significantly lower glucose variability indices, lower daily insulin requirement and hemoglobin A1c in the group of sitagliptin plus insulin (P<0.01). After steamed bun test, past-meal GLP-1 levels at 30 min were higher (P<0.01) while GIP levels were lower (P<0.01), with glucagon suppression in the sitagliptin plus insulin group. No significant change was observed at any time point in placebo plus insulin group.
  
  
  CONCLUSIONS
  Sitagliptin significantly decreases blood glucose level and blood glucose fluctuation, which may contribute to the ability of sitagliptin in decreasing glucagon secretion.
authors.affiliation: Department of Endocrinology, Subei People's Hospital, Yangzhou Jiangsu 225000, China.
authors.forename: Na
authors.initials: N
authors.lastname: Luo
authors.affiliation: Department of Endocrinology, Subei People's Hospital, Yangzhou Jiangsu 225000, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Endocrinology, Subei People's Hospital, Yangzhou Jiangsu 225000, China.
authors.forename: Zhenwen
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Endocrinology, Subei People's Hospital, Yangzhou Jiangsu 225000, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Endocrinology, Subei People's Hospital, Yangzhou Jiangsu 225000, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005749:Gastric Inhibitory Polypeptide / Q000097:blood; D005934:Glucagon / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D000068900:Sitagliptin Phosphate / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D054873:Dipeptidyl-Peptidase IV Inhibitors; D005749:Gastric Inhibitory Polypeptide; D005934:Glucagon; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000068900:Sitagliptin Phosphate