Diabetes Metab J.  2015 Aug;39(4):335-341. 10.4093/dmj.2015.39.4.335.

Effects of 6-Month Sitagliptin Treatment on Insulin and Glucagon Responses in Korean Patients with Type 2 Diabetes Mellitus

• Yang HK
• Kang B
• Lee SH
• Kim HS
• Yoon KH
• Cha BY
• Cho JH

• KMID: 2174030
• DOI: http://doi.org/10.4093/dmj.2015.39.4.335

Abstract

BACKGROUND
This study aimed to evaluate the effect of sitagliptin, an oral dipeptidyl peptidase-4 inhibitor, on insulin secretion and glucagon suppression in Korean subjects with type 2 diabetes mellitus.
METHODS
Twenty-four subjects underwent a 75-g oral glucose tolerance test (OGTT) before and after 6 months of sitagliptin treatment. Sitagliptin, insulin, and sulfonylurea were withdrawn for 3 days before OGTT to eliminate any acute effects on beta-cell insulin or alpha-cell glucagon secretion. Venous samples were drawn five times during each OGTT to measure plasma glucose, insulin, and glucagon. Indices on insulin secretion and resistance were calculated.
RESULTS
Early phase insulin secretion, measured by the insulinogenic index significantly increased after 6 months of sitagliptin treatment, especially in the higher baseline body mass index group and higher baseline glycosylated hemoglobin (HbA1c) group. There were no significant differences in the insulin resistance indices before and after sitagliptin treatment. Although no significant differences were observed in the absolute levels of glucagon and the glucagon-to-insulin ratio, there was a significant reduction in the percentile change of glucagon-to-insulin ratio at 30- and 120-minute during the OGTT.
CONCLUSION
Although the HbA1c level did not decrease significantly after 6 months of sitagliptin treatment, an increase in insulin secretion and reduction in early phase postprandial plasma glucagon-to-insulin ratio excursion was confirmed in Korean subjects with type 2 diabetes.

Keyword

Dipeptidyl-peptidase 4 inhibitors; Glucagon; Glucose tolerance test; Insulin; Korea

MeSH Terms

Blood Glucose
Body Mass Index
Diabetes Mellitus, Type 2*
Dipeptidyl-Peptidase IV Inhibitors
Glucagon*
Glucose Tolerance Test
Hemoglobin A, Glycosylated
Humans
Insulin Resistance
Insulin*
Korea
Plasma
Sitagliptin Phosphate
Dipeptidyl-Peptidase IV Inhibitors
Glucagon
Insulin

Figure

• 

  Fig. 1 Changes in plasma glucose (A), insulin (B), and glucagon (C), insulin-to-glucose ratio (D), glucagon-to-insulin ratio (E) and percent change of glucagon-to-insulin ratio (F) response during 75-g oral glucose tolerance test (OGTT) before and after sitagliptin treatment. Values are presented as mean±standard error. (Glucagon/insulin) %change=100×[(glucagon/insulin at 30, 60, 90, or 120-minute)-(glucagon/insulin at 0 minute)]/(glucagon/insulin at 0 minute). Open circles and dashed lines indicate measures before sitagliptin treatment; closed squares and solid lines indicate measures after sitagliptin treatment. "P for trend" indicates the comparison of time course curves during OGTT, analyzed by repeated measures analysis of variance. aP<0.05 at the 0, 30, 60, 90, or 120-minute time points using Wilcoxon signed rank test for paired values.

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