Effectiveness of sitagliptin phosphate on glucose-lowering and glycemic variability in newly diagnosed type 2 diabetes patients treated with intensive insulin therapy

Objective To access the glucose-lowering effect and glycemic variability of dipeptidyl peptidase 4 inhibitor sitagliptin phosphate combined intensive insulin therapy for newly diagnosed type 2 diabetes patients. Methods A prospective study was conducted in 94 newly diagnosed type 2 diabetes patients with HbA1c above 9% admitted to Hainan Hospital of Chinese PLA General Hospital from January 2017 to December 2017. All the subjects were randomly divided into DPP-4 inhibitor(Sitagliptin)group and control group. The glucose-lowering effect and glycemic variability parameters of two groups were compared. Results There were 45 patients in the DPP-4 inhibitor group, and 49 patients in the control group. No significant difference was found in age, gender,course of disease, BMI, family history, HbA1 c, HOMA-β, HOMA-IR, serum insulin and C peptide between two groups(all P>0.05).At the end of a 7-day therapy, the mean blood glucose(9.36±1.21 mmol/L vs 10.01±1.48 mmol/L, HR=0.024), fasting plasma glucose(8.76±1.10 mmol/L vs 9.37±1.59 mmol/L, HR=0.034), postprandial blood glucose(9.94±1.48 mmol/L vs 10.71±1.74 mmol/L,HR=0.025), standard deviation of blood glucose(2.52±0.63 mmol/L vs 2.91±0.90 mmol/L, HR=0.021), largest amplitude of glycemic excursion(9.34±2.19 mmol/L vs 10.52±2.78 mmol/L, HR=0.026), postprandial glycemic excursion(2.59±0.78 mmol/L vs3.01±1.16 mmol/L, HR=0.042), mean amplitude of glycemic excursions(5.11±1.31 mmol/L vs 5.83±1.53 mmol/L, HR=0.017) in the DPP-4 inhibitor group were significantly lower than those in the control group. Number of glycemic excursions(6.02±1.88 vs7.17±1.77, HR=0.004), mean of daily differences(1.26±0.51 mmol/L vs 1.50±0.43 mmol/L, HR=0.024), incidence of hypoglycemia3 cases(6.67%) vs 7 cases(14.29%), P<0.001 of DPP-4 inhibitor group were also significantly lower than those of control group. Conclusion Dipeptidyl peptidase 4 inhibitors combined with intensive insulin therapy is more effective in terms of glycemic lowering as well as maintaining euglycaemia for newly diagnosed type 2 diabetes patients.