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Mori Y.,Jikei University School of Medicine | Taniguchi Y.,Metabolism and Endocrinology Center | Miyazaki S.,Metabolism and Endocrinology Center | Yokoyama J.,Jikei University School of Medicine | Utsunomiya K.,Jikei University School of Medicine
Therapeutic Research | Year: 2013

Objectives : Mitiglinide and voglibose were examined for their effects, when used alone or in combination, on diurnal glycemic fluctuations and postprandial insulin-secretory dynamics in type 2 diabetic patients. Patients and Methods : Once stable glycemic control had been achieved in 6 patients with type 2 diabetes, they were continuously monitored for their diurnal glucose fluctuations by using continuous glucose monitoring and also examined postprandial insulin-secretory dynamics for 4 consecutive days. Of these patients, 3 patients were given diet therapy on day 1, voglibose 0.6 mg/day alone on day 2, mitiglinide 30 mg/day alone on day 3, voglibose 0.6 mg/day and mitiglinide 30 mg/day on day 4, while the remaining 3 patients were given the same treatments except that they were given mitiglinide and voglibose on days 2 and 3, respectively. Results : The glycemic fluctuations were suppressed with voglibose or mitiglinide alone but were further suppressed with combination therapy with voglibose and mitiglinide. Again, all parameters used to evaluate the range of diurnal glycemic fluctuations were significantly decreased with combination therapy, compared to diet therapy. Additionally, while diet therapy was associated with decreased early insulin secretion and insulin peaks occurring 90 minutes postprandially, mitiglinide was associated with increased early insulin secretion and earlier insulin peaks. Again, combination therapy was associated with lower insulin peaks and lower insulin secretion from 60 minutes postprandially onwards, compared to mitiglinide alone. Conclusions : Less bolus insulin secretion was required for combination therapy with voglibose and mitiglinide than mitiglinide alone to effectively suppress postprandial glucose excursions. Source


Mori Y.,Jikei University School of Medicine | Taniguchi Y.,Metabolism and Endocrinology Center | Miyazaki S.,Metabolism and Endocrinology Center | Yokoyama J.,Jikei University School of Medicine | Utsunomiya K.,Jikei University School of Medicine
Diabetes Technology and Therapeutics | Year: 2013

Background: In an earlier continuous glucose monitoring (CGM)-based study, we reported that sitagliptin not only reduced 24-h mean glucose levels but also suppressed postprandial glucose increases, thus reducing the range of glycemic fluctuations in type 2 diabetes patients. In this study, we investigated whether sitagliptin might provide similar benefits in type 2 diabetes patients receiving insulin therapy by using CGM. Patients and Methods: The study included a total of 13 type 2 diabetes patients in whom stable glycemic control had been achieved after admission for glycemic control. Insulin regimens used included long-acting insulin preparations once daily in four patients and biphasic insulin preparations twice daily in nine, with the daily insulin dose being 19.0±12.7 U. During the CGM-based study, the patients were given insulin therapy alone on Days 1 and 2 and were given sitagliptin 50 mg/day as add-on treatment on Days 3-6, with their daily insulin doses maintained. Results: The add-on treatment with sitagliptin led to significant decreases in 24-h mean glucose levels and SDs of 288 glucose levels measured by CGM for 24 h, as well as in the indices for magnitude of glucose variability and proportion of time in hyperglycemia, compared with insulin therapy alone (P<0.01), whereas there was no significant change seen in regard to the proportion of time in hypoglycemia with or without add-on treatment with sitagliptin. Conclusions: This CGM-based study clearly demonstrated that insulin therapy alone, whether with long-acting or biphasic insulin preparations, does not provide adequate glycemic control in type 2 diabetes patients. In contrast, add-on sitagliptin was shown to narrow the range of 24-h glucose fluctuations in these patients, suggesting that add-on treatment with sitagliptin is effective for postprandial glucose control in type 2 diabetes patients receiving insulin therapy. © Mary Ann Liebert, Inc. Source

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