Efficacy and safety of teneligliptin in addition to insulin therapy in type 2 diabetes mellitus patients on hemodialysis evaluated by continuous glucose monitoring
Introduction
Diabetic nephropathy is a leading cause of end-stage renal disease (ESRD) in developed countries [1], [2]. Recent studies have suggested that poor glycemic control is associated with higher mortality in diabetes mellitus (DM) patients on hemodialysis (HD) [3], [4], [5]. These patients are at a high risk of life-threatening hypoglycemia [6], which is associated with an increased risk of cardiovascular events, hospitalization, and mortality [7]. Therefore, appropriate glycemic control without harmful hypoglycemia is required in this population.
Dipeptidyl peptidase-4 (DPP-4) inhibitors have recently been introduced as promising oral anti-diabetic drugs and are expected to improve glycemic control with a low risk of hypoglycemia and weight gain [8]. Teneligliptin, a novel DPP-4 inhibitor, can be used for glycemic control without dose adjustment for treating type 2 DM patients on HD. A few studies have reported that teneligliptin monotherapy can improve glycemic control without hypoglycemia in DM patients on HD [9], [10]. However, the efficacy and safety of a combination therapy comprising teneligliptin and insulin are unknown. Thus, in this study, we used continuous glucose monitoring (CGM) to evaluate the efficacy and safety of adding teneligliptin to insulin therapy in type 2 DM patients on HD.
Section snippets
Patients
Twenty-one insulin-treated type 2 DM patients on HD who were observed at the outpatient clinic of Matsunami General Hospital between September 2014 and August 2015 were recruited for this study and followed up for 24 weeks. Type 1 DM patients were excluded. All patients underwent regular HD three times a week with a high-flux membrane and standard bicarbonate dialysate that contained 7.0 mmol/L of glucose.
This study adhered to the principles of the Declaration of Helsinki, and all patients
Clinical and laboratory characteristics at baseline
The clinical characteristics of all patients (N = 21) are summarized in Table 1. All patients were initially treated with only insulin (8 insulin lispro, 4 insulin lispro with insulin glargine, 7 insulin lispro with insulin degludec, and 2 insulin glargine).
Insulin dose before and after teneligliptin administration
In all patients, there were reductions of 0–4 U/day in the doses of long-acting insulin (insulin glargine and insulin degludec) and 2–4 U/immediately before each meal in the doses of rapid-acting insulin (insulin lispro) when teneligliptin was
Discussion
Blood glucose control in DM patients on HD is very difficult. Hypoglycemia frequently occurs in DM patients with ESRD because of the loss of dietary intake, decrease in renal gluconeogenesis, decrease in insulin clearance, and decrease in metabolism and clearance of drugs [6]. Glycemic fluctuations are greater on HD days, and this may also lead to an increase in the risk of hypoglycemia [12], [13]. In the present study, CGM was used to evaluate the pattern of blood glucose fluctuation.
Before
Conclusion
Teneligliptin may reduce the total daily dose of insulin and prevent hypoglycemic events on the HD day in type 2 DM patients on HD.
Conflicts of interest
None.
References (26)
- et al.
Serum albumin-adjusted glycated albumin is a better predictor of mortality in diabetic patients with end-stage renal disease on hemodialysis
J Diabetes Complications
(2016) - et al.
Improved glycemic control with teneligliptin in patients with type 2 diabetes mellitus on hemodialysis: evaluation by continuous glucose monitoring
J Diabetes Complications
(2015) - et al.
Serum C-peptide concentrations poorly phenotype type 2 diabetic end-stage renal disease patients
Kidney Int
(2000) - et al.
An overview of regular dialysis treatment in Japan (As of 31 December 2013)
Ther Apher Dial
(2015) US Renal Data System 2015 annual data report: epidemiology of kidney disease in the United States
Am J Kidney Dis
(2016)- et al.
Glycated albumin and risk of death and hospitalizations in diabetic dialysis patients
Clin J Am Soc Nephrol
(2011) - et al.
Glycated albumin predicts the risk of mortality in type 2 diabetic patients on hemodialysis: evaluation of a target level for improving survival
Ther Apher Dial
(2014) - et al.
Haemodialysis-induced hypoglycaemia and glycaemic disarrays
Nat Rev Nephrol
(2015) - et al.
Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes: a nationwide population-based study
Diabetes Care
(2013) Dipeptidyl peptidase-4 inhibitors in the treatment of type 2 diabetes: a comparative review
Diabetes Obes Metab
(2011)