title: Short and Long Term Effects of a DPP-4 Inhibitor Versus Bedtime NPH Insulin as ADD-ON Therapy in Patients with Type 2 Diabetes.
abstract: We conducted a comparison between the dipeptidyl-peptidase-4(DPP-4) inhibitor sitagliptin versus NPH insulin as an add-on therapies in patients with type 2 diabetes mellitus (T2D) failing oral medications. The objective was to ascertain the better indication in long-duration diabetes.
  
  
  
  thirty-five T2D patients inadequately controlled with metformin plus glyburide were randomized to receive sitagliptin (n=18) or bedtime NPH insulin (n=17) for 12 months. HbA1c levels and a metabolic and hormonal profile at fasting and post-meal (every 30 minutes for 4 hours) were evaluated before and after 6 months (short-term) and 12 months (long-term) after adding sitagliptin or bedtime NPH insulin to their drug regime.
  
  
  
  Sitagliptin and NPH insulin decreased HbA1c levels equally after 6 months (p<0.001) with no further improvement after 12 months: sitagliptin (8.1±0.7% vs. 7.3±0.8% vs. 7.4±1.9%) and insulin (8.1±0.6% vs. 7.3±0.7% vs. 7.2±1.0%). Fasting glucose, fasting and postprandial triglyceride and C-peptide levels were also reduced by NPH insulin whereas postprandial insulin was decreased by sitagliptin. Body weight and postchallenge free fatty acid levels increased with insulin treatment. The transitory suppression (at 6 months) of postprandial proinsulin levels with both therapies, and of glucagon with sitagliptin, was followed by values similar or worse to those at pre-treatment.
  
  
  
  The use of either NPH insulin or a DPP-4 inhibitor as add-on treatments improves glucose control in patients with T2D failing on metformin plus glyburide therapy. The results were not attributed to a permanent improvement in alpha or beta cell function in patients with long-duration diabetes.
authors.forename: Giordana Maluf
authors.initials: GM
authors.lastname: da Silva
authors.forename: Katia Camarano
authors.initials: KC
authors.lastname: Nogueira
authors.forename: Rosa Tsuneshiro
authors.initials: RT
authors.lastname: Fukui
authors.forename: Marcia Regina Soares
authors.initials: MR
authors.lastname: Correia
authors.forename: Rosa Ferreira
authors.initials: RF
authors.lastname: Dos Santos
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Av Dr Arnaldo, 455 sala 3324. Sao Paulo/SP - 01246-903, Brazil.
authors.forename: Maria Elizabeth Rossi
authors.initials: ME
authors.lastname: da Silva
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000068900:Sitagliptin Phosphate / Q000008:administration & dosage / Q000627:therapeutic use*; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D054873:Dipeptidyl-Peptidase IV Inhibitors; D007328:Insulin; D014280:Triglycerides; D005947:Glucose; D000068900:Sitagliptin Phosphate
keywords: C peptide; Proinsulin.; Type 2 diabetes mellitus; bedtime NPH insulin; dipeptidyl-peptidase-4 inhibitor; glucagon; glucagon-like peptide 1