title: Effects of sitagliptin as initial therapy in newly diagnosed elderly type 2 diabetics: A randomized controlled study.
abstract: The objective of this study was to investigate the characteristics of blood glycemic excursion, incretins and pancreatic hormone secretion in elderly people with newly diagnosed type 2 diabetes mellitus (T2DM) and to study the effects of sitagliptin on glycemic excursion in these subjects. A total of 129 newly diagnosed T2DM patients were enrolled in the study from March 2012 to August 2013. Clinical data, serum incretin, pancreatic hormone and continuous glucose monitoring data were collected. Among these subjects, elderly patients (NEDM) randomly received metformin combined with sitagliptin phosphate or glimepiride for 24 weeks. The blood glucose, glycosylated hemoglobin A1c(GHbA1c), serum incretins and pancreatic hormone levels were determined. During the oral glucose tolerance test (OGTT), 30 min insulin and C-peptide levels, 120 min insulin levels and ratio of the increases of insulin and blood glucose levels after 30 min of sugar loading (∆Ins30/∆Glu30) were significantly lower in elderly patients than in middle-aged patients (P<0.05). In addition, the glucagon elevation at 30 min was higher and the glucagon-like peptide-1 (GLP-1) at 30 min was lower in the elderly patients (P<0.05). Glucose excursion indices, including the standard deviation of the average blood glucose, intraday mean average glucose excursions (MAGE), and mean of daily differences (MODD), were significantly higher in the elderly patients (P<0.05). During the OGTT, insulin, C-peptide and ∆Ins30/∆Glu30 results at 30 min and GLP-1 levels at 120 min in NEDM subjects were significantly increased (P<0.05) and glucagon levels at 30 min was significantly lower after sitagliptin treatment (P<0.05) compared with glimepiride. Moreover, MAGE and MODD were significantly lower in the sitagliptin group after treatment compared to those in the glimepiride group (P<0.05). No severe hypoglycemia or cardiovascular diseases were observed. Strong blood glucose excursions occur in elderly patients with newly diagnosed T2DM. Sitagliptin phosphate combined with metformin effectively and safely improves glycemic excursion and carbohydrate metabolism in NEDM patients by promoting the first phase of insulin and incretin secretion and inhibiting glucagon secretion of.
authors.affiliation: Department of Nephrology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Xiao
authors.affiliation: Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.
authors.forename: Xiaopei
authors.initials: X
authors.lastname: Cui
authors.affiliation: Department of Emergency, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.
authors.forename: Jianbo
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.
authors.forename: Zhenxia
authors.initials: Z
authors.lastname: Han
authors.affiliation: Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.
authors.forename: Nan
authors.initials: N
authors.lastname: Chen
authors.affiliation: Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.
authors.forename: Baoying
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.
authors.forename: Mei
authors.initials: M
authors.lastname: Cheng
authors.affiliation: Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.
authors.forename: Haiqing
authors.initials: H
authors.lastname: Gao
authors.affiliation: Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.
authors.forename: Kuanxiao
authors.initials: K
authors.lastname: Tang
keywords: elderly; glycemic excursion; incretins; sitagliptin; type 2 diabetes