Hemoglobin glycation index as a useful predictor of therapeutic responses to dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes.
BACKGROUND
A high hemoglobin glycation index (HGI) and glycated hemoglobin (HbA1c) level are associated with greater inflammatory status, and dipeptidyl peptidase-4 (DPP-4) inhibitors can suppress inflammation. We aimed to evaluate the relationship between HGI and the therapeutic effect of DPP-4 inhibitors.


METHODS
This retrospective cohort study followed 468 patients with type 2 diabetes receiving DPP-4 inhibitor treatment for 1 year. Estimated HbA1c was calculated using a linear regression equation derived from another 2969 randomly extracted patients with type 2 diabetes based on fasting plasma glucose (FPG) level. The subjects were divided into two groups based on HGI (HGI = observed HbA1c - estimated HbA1c). Mixed model repeated measures were used to compare the treatment efficacy after 1 year in patients with a low (HGI<0, n = 199) and high HGI (HGI≧0, n = 269).


RESULTS
There were no significant group differences in mean changes of FPG after 1 year (-12.8 and -13.4 mg/dL in the low and high HGI groups, respectively). However, the patients with a high HGI had a significantly greater reduction in HbA1c from baseline compared to those with a low HGI (-1.9 versus -0.3% [-20.8 versus -3.3 mmol/mol]). Improvements in glycemic control were statistically significantly associated with the tested DPP-4 inhibitors in the high HGI group (-2.4, -1.4, -1.2 and -2.2% [-26.2, -15.3, -13.1 and -24.0 mmol/mol] for vildagliptin, linagliptin, saxagliptin and sitagliptin, respectively) but not in the low HGI group.


CONCLUSIONS
The HGI index derived from FPG and HbA1c may be able to identify who will have a better response to DPP-4 inhibitors.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Yu-Wei
YW
Chen
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|School of Medicine, National Yang Ming University, Taipei, Taiwan.
Jun-Sing
JS
Wang
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|School of Medicine, National Yang Ming University, Taipei, Taiwan.|College of Medicine, National Defense Medical Center, Taipei, Taiwan.
Wayne H-H
WH
Sheu
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|School of Medicine, National Yang Ming University, Taipei, Taiwan.|Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.
Shih-Yi
SY
Lin
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|School of Medicine, National Yang Ming University, Taipei, Taiwan.
I-Te
IT
Lee
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Yuh-Min
YM
Song
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan.
Chia-Po
CP
Fu
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.|Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
Chia-Lin
CL
Lee
D000218:Adamantane / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D054316:Biomarkers, Pharmacological / Q000097:blood*; D001786:Blood Glucose / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy*; D004151:Dipeptides / Q000627:therapeutic use; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis / Q000378:metabolism*; D006305:Health Status Indicators; D006801:Humans; D000069476:Linagliptin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009570:Nitriles / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011379:Prognosis; D011759:Pyrrolidines / Q000627:therapeutic use; D012189:Retrospective Studies; D000068900:Sitagliptin Phosphate / Q000627:therapeutic use; D016896:Treatment Outcome; D000077597:Vildagliptin
D000218:Adamantane; D054316:Biomarkers, Pharmacological; D001786:Blood Glucose; D004151:Dipeptides; D054873:Dipeptidyl-Peptidase IV Inhibitors; D006442:Glycated Hemoglobin; D000069476:Linagliptin; D009570:Nitriles; D011759:Pyrrolidines; D000068900:Sitagliptin Phosphate; D000077597:Vildagliptin; C502994:saxagliptin