Comparative effectiveness of sitagliptin and vildagliptin in the management of patients with type 2 diabetes mellitus undergoing haemodialysis: an Indian rural tertiary care centre experience
Keywords:Comparative effectiveness, Diabetic nephropathy, Dipeptidyl peptidase-4 (DPP-4) inhibitors, Gliptins, Haemodialysis, Type 2 diabetes mellitus
Background: The prevalence of chronic kidney disease is increasing with diabetic nephropathy as the common underlying cause. Although numerous drugs are being used to improve glycaemic control, evidence in patients with diabetic nephropathy is sparse. The aim of the present was to evaluate the effectiveness of sitagliptin or vildagliptin addition on glycaemic control in patients with T2DM undergoing haemodialysis as part of their routine care in a rural tertiary care setting.
Methods: Type 2 diabetic patients on maintenance haemodialysis as part of routine care and whose glycaemia was not controlled adequately and prescribed one of the oral gliptins once daily in addition to existing therapy for a period of 24 weeks were included in the present study. Effectiveness was assessed in terms of glycaemic control as measured by the change over time in glycated haemoglobin. Data analysis included glycated haemoglobin, body weight, serum creatinine, urine albumin creatinine ratio and the occurrence of hypoglycaemia.
Results: Significant reduction in glycated haemoglobin values were noted after 24 weeks of therapy with gliptins similar to insulin glargine with a small weight loss. There was an insignificant decrease in the serum creatinine and urine albumin excretion levels after treatment with vildagliptin with Vildagliptin producing a slightly higher decrease but there was no correlation with changes in A1c levels. The overall incidence of adverse experiences was low and generally mild in both groups.
Conclusions: In a group of Asian Indian patients with diabetic nephropathy due to T2DM undergoing haemodialysis in whom glycaemia was not controlled adequately, addition of gliptins helped to achieve glycaemic control to a similar extent as insulin glargine but with a marginal weight advantage.
Tahrani AA, Barnett AH, Bailey CJ. Pharmacology and therapeutic implications of current drugs for type 2 diabetes mellitus. Nat Rev Endocrinol. 2016 Oct;12(10):566-92.
Vijayan M, Radhakrishnan S, Abraham G, Mathew M, Sampathkumar K, Mancha NP. Diabetic kidney disease patients on hemodialysis: a retrospective survival analysis across different socioeconomic groups. Clin Kidney J. 2016 Dec;9(6):833-8.
Rhee CM, Leung AM, Kovesdy CP, Lynch KE, Brent GA, Kalantar-Zadeh K. Updates on the Management of Diabetes in Dialysis Patients. Seminars in dialysis. 2014;27(2):135-45.
Arnouts P, Bolignano D, Nistor I, Bilo H, Gnudi L, Heaf J, et al. Glucose-lowering drugs in patients with chronic kidney disease: a narrative review on pharmacokinetic properties. Nephrol Dial Transplant. 2014 Jul;29(7):1284-300.
Abe M, Okada K. DPP-4 Inhibitors in Diabetic Patients with Chronic Kidney Disease and End-Stage Kidney Disease on Dialysis in Clinical Practice. Contrib Nephrol. 2015;185:98-115.
Scheen AJ. Pharmacokinetics and clinical use of incretin-based therapies in patients with chronic kidney disease and type 2 diabetes. Clin Pharmacokinet. 2015 Jan;54(1):1-21.
Wang W, Zhou X, Kwong JSW, Li L, Li Y, Sun X. Efficacy and safety of thiazolidinediones in diabetes patients with renal impairment: a systematic review and meta-analysis. Sci Rep. 2017 May 11;7(1):1717.
Mohan Dallumal R, Chua SS, Wu DB, Vethakkan SR. Sitagliptin: Is It Effective in Routine Clinical Practice? Int J Endocrinol. 2015;2015:950571.
Chen TY, Hsieh CJ. Real-world effectiveness of sitagliptin as add-on therapy in patients with type 2 diabetes mellitus. Postgrad Med. 2014 May;126(3):205-15.
Nyeland ME, Ploug UJ, Richards A, Garcia Alvarez L, Demuth D, Muthutantri A, et al. Evaluation of the effectiveness of liraglutide and sitagliptin in type 2 diabetes: a retrospective study in UK primary care. Int J Clin Pract. 2015 Mar;69(3):281-91.
Ghosh S, Trivedi S, Sanyal D, Modi KD, Kharb S. Teneligliptin real-world efficacy assessment of type 2 diabetes mellitus patients in India (TREAT-INDIA study). Diabetes Metab Syndr Obes. 2016 Nov 8;9:347-53.
Liew BS, Perry C, Boulton-Jones JM, Simpson K, Paterson K. Diabetic nephropathy: an observational study on patients attending a joint diabetes renal clinic. QJM. 1997 May;90(5):353-8.
Sudhakaran C, Kishore U, Anjana RM, Unnikrishnan R, Mohan V. Effectiveness of sitagliptin in Asian Indian patients with type 2 diabetes-an Indian tertiary diabetes care center experience. Diabetes Technol Ther. 2011 Jan;13(1):27-32.
Ito M, Abe M, Okada K, Sasaki H, Maruyama N, Tsuchida M, et al. The dipeptidyl peptidase-4 (DPP-4) inhibitor vildagliptin improves glycemic control in type 2 diabetic patients undergoing hemodialysis. Endocr J. 2011;58(11):979-87.
Arjona Ferreira JC, Corry D, Mogensen CE, Sloan L, Xu L, Golm GT, et al. Efficacy and safety of sitagliptin in patients with type 2 diabetes and ESRD receiving dialysis: a 54-week randomized trial. Am J Kidney Dis. 2013;61(4):579-87.
Kume S, Uzu T, Takagi C, Kondo M, Okabe T, Araki S, et al. Efficacy and tolerability of vildagliptin in type 2 diabetic patients on hemodialysis. J Diabetes Investig. 2012;3(3):298-301.
Ito H, Mifune M, Matsuyama E, Furusho M, Omoto T, Shinozaki M, et al. Vildagliptin is Effective for Glycemic Control in Diabetic Patients Undergoing either Hemodialysis or Peritoneal Dialysis. Diabetes Ther. 2013;4(2):321-9.
Penno G, Garofolo M, Del Prato S. Dipeptidyl peptidase-4 inhibition in chronic kidney disease and potential for protection against diabetes-related renal injury. Nutr Metab Cardiovasc Dis. 2016 May;26(5):361-73.