There has been concern as to whether dipeptidyl peptidase-4 (DPP-4) inhibitors can be used safely in patients with relatively good
glycemic control. This study, approved by the institutional review board of Hanzoumon Diabetes City Atlas Clinic, examined whether
DPP-4 inhibitor sitagliptin could safely achieve good
glycemic control without severe
hypoglycemia by employing the "added food" concept. The subjects were 60 patients (46 men and 14 women) with
type 2 diabetes who started
sitagliptin therapy during a 1-month period from December 15, 2009 to January 15, 2010. They were recommended to have added food between meals to prevent
hypoglycemia, while maintaining the same daily calorie intake. HbA(1c) decreased from 7.1 ± 1.2% to 6.5 ± 0.6% after 6 months of
sitagliptin treatment (p < 0.001). In patients with a baseline HbA(1c) <7%, it decreased from 6.5 ± 0.3% to 6.1 ± 0.4% (p < 0.001). Systolic blood pressure was significantly reduced from 127.7 ± 17.0 to 122.7 ± 17.9 mmHg in the patients with a baseline HbA(1c) < 7% (p = 0.018). However,
body weight increased by approximately 900 g and
high-density lipoprotein cholesterol decreased significantly from 1.57 ± 0.46 to 1.43 ± 0.35 mmol/L (p < 0.01) in the patients concomitantly receiving sulfonylureas with
sitagliptin. Excellent
glycemic control was achieved by
sitagliptin treatment together with the added food concept. However, combined use of
sitagliptin with sulfonylureas requires attention to
weight gain and the
lipid profile. Further clinical studies will elucidate whether
sitagliptin can decrease cardiovascular events as well as normalizing
blood glucose and lowering the blood pressure.