Endocrinol Metab.  2015 Mar;30(1):84-91. 10.3803/EnM.2015.30.1.84.

Optimal Candidates for the Switch from Glimepiride to Sitagliptin to Reduce Hypoglycemia in Patients with Type 2 Diabetes Mellitus

• Kim HM
• Lim JS
• Lee BW
• Kang ES
• Lee HC
• Cha BS

• KMID: 2407109
• DOI: http://doi.org/10.3803/EnM.2015.30.1.84

Abstract

BACKGROUND
Sitagliptin is a novel antidiabetic agent with a low risk for hypoglycemia. We investigated the efficacy and safety of sitagliptin when patients switched from a sulfonylurea to sitagliptin and identified good candidates for the switch.
METHODS
Sixty-one patients with type 2 diabetes switched from glimepiride with metformin to sitagliptin with metformin due to clinical hypoglycemia. Serum glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2-hour postprandial plasma glucose (2h-PPG) before and 12 and 24 weeks after the drug switch were checked.
RESULTS
HbA1c and FPG levels did not change 12 or 24 weeks after the switch; however, the 2h-PPG level decreased from 218.0+/-67.5 mg/dL at baseline to 197.1+/-69.9 mg/dL at 12 weeks and 192.3+/-67.4 mg/dL at 24 weeks after switching drugs (P=0.045, P=0.018, respectively). All but one patient no longer experienced hypoglycemia after discontinuing glimepiride. In a multivariate logistic regression analysis, a high homeostasis model assessment of insulin resistance and low baseline HbA1c level were independent predictors of an HbA1c < or =7% after switching to sitagliptin.
CONCLUSION
Glycemic control was not aggravated in patients 24 weeks after the drug switch, and symptomatic hypoglycemia decreased significantly. Patients with dominant insulin resistance may be good candidates for switching from a sulfonylurea to sitagliptin to reduce hypoglycemia.

Keyword

DPP-4 inhibitors; Hypoglycemia; Diabetes mellitus, type 2

MeSH Terms

Blood Glucose
Diabetes Mellitus, Type 2*
Fasting
Hemoglobin A, Glycosylated
Homeostasis
Humans
Hypoglycemia*
Insulin Resistance
Logistic Models
Metformin
Sitagliptin Phosphate
Metformin

Figure

• 

  Fig. 1 (A) Changes in glycated hemoglobin (HbA1c), (B) fasting plasma glucose (FPG), (C) 2-hour postprandial glucose (2h-PPG) values in all patients, (D) HbA1c in group 1 (HbA1c ≤7% at 12 weeks after switching), and (E) HbA1c in group 2 (HbA1c >7% at 12 weeks after switching) before and after switching from glimepiride to sitagliptin. Data are presented as the mean±SD. Paired t test. aP<0.05 vs. baseline.

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