Endocrinol Metab.  2017 Jun;32(2):241-247. 10.3803/EnM.2017.32.2.241.

Effects of Vildagliptin or Pioglitazone on Glycemic Variability and Oxidative Stress in Patients with Type 2 Diabetes Inadequately Controlled with Metformin Monotherapy: A 16-Week, Randomised, Open Label, Pilot Study

• Kim NH
• Kim DL
• Kim KJ
• Kim NH
• Choi KM
• Baik SH
• Kim SG

• KMID: 2384083
• DOI: http://doi.org/10.3803/EnM.2017.32.2.241

Abstract

BACKGROUND
Glycemic variability is associated with the development of diabetic complications through the activation of oxidative stress. This study aimed to evaluate the effects of a dipeptidyl peptidase 4 inhibitor, vildagliptin, or a thiazolidinedione, pioglitazone, on glycemic variability and oxidative stress in patients with type 2 diabetes.
METHODS
In this open label, randomised, active-controlled, pilot trial, individuals who were inadequately controlled with metformin monotherapy were assigned to either vildagliptin (50 mg twice daily, n=17) or pioglitazone (15 mg once daily, n=14) treatment groups for 16 weeks. Glycemic variability was assessed by calculating the mean amplitude of glycemic excursions (MAGE), which was obtained from continuous glucose monitoring. Urinary 8-iso prostaglandin F₂α, serum oxidised low density lipoprotein, and high-sensitivity C-reactive protein were used as markers of oxidative stress or inflammation.
RESULTS
Both vildagliptin and pioglitazone significantly reduced glycated hemoglobin and mean plasma glucose levels during the 16-week treatment. Vildagliptin also significantly reduced the MAGE (from 93.8±38.0 to 70.8±19.2 mg/dL, P=0.046), and mean standard deviation of 24 hours glucose (from 38±17.3 to 27.7±6.9, P=0.026); however, pioglitazone did not, although the magnitude of decline was similar in both groups. Markers of oxidative stress or inflammation including urinary 8-iso prostaglandin F₂α did not change after treatment in both groups.
CONCLUSION
In this 16-week treatment trial, vildagliptin, but not pioglitazone, reduced glycemic variability in individuals with type 2 diabetes who was inadequately controlled with metformin monotherapy, although a reduction of oxidative stress markers was not observed.

Keyword

Glycemic variability; Dipeptidyl-peptidase IV inhibitors; Thiazolidinediones; Diabetes mellitus, type 2

MeSH Terms

Blood Glucose
C-Reactive Protein
Diabetes Complications
Diabetes Mellitus, Type 2
Dipeptidyl Peptidase 4
Dipeptidyl-Peptidase IV Inhibitors
Glucose
Hemoglobin A, Glycosylated
Humans
Inflammation
Lipoproteins
Metformin*
Oxidative Stress*
Pilot Projects*
Thiazolidinediones
C-Reactive Protein
Dipeptidyl Peptidase 4
Dipeptidyl-Peptidase IV Inhibitors
Glucose
Lipoproteins
Metformin
Thiazolidinediones

Figure

• 

  Fig. 1 Overall study design. CGM, continuous glucose monitoring; F/U, follow-up.

• 

  Fig. 2 Changes of (A) mean amplitude of glycemic excursion (MAGE) and (B) standard deviation (SD) before and after 16 weeks of treatment in the vildagliptin and pioglitazone groups. aP<0.05.

• 

  Fig. 3 Changes of mean amplitude of glycemic excursion before and after 16 weeks of treatment in the (A) vildagliptin and (B) pioglitazone groups on individual levels.

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