Abstract
Objective: This retrospective study was undertaken to compare hemoglobin A1c and glycoalbumin levels as glycemic control indicators during linagliptin treatment in diabetic patients with or without nephropathy. The efficacy and safety of linagliptin were also examined. Methods: The subjects were 127 outpatients with type 2 diabetes, including 69 patients with nephropathy. The hypoglycemic effect of linagliptin and the factors contributing to its hypoglycemic effect were examined. Several clinical parameters were compared before and after the initiation of linagliptin to evaluate the drug’s safety. Results: Linagliptin significantly decreased hemoglobin A1c and glycoalbumin levels at 3 and 6 months after treatment initiation. At 6 months, changes in hemoglobin A1c levels from baseline were strongly correlated with changes in glycoalbumin levels in diabetic patients with and without nephropathy. Changes in hemoglobin A1c and glycoalbumin at 6 months were significantly greater in patients with higher baseline values and shorter diabetes duration. Linagliptin decreased both hemoglobin A1c and glycoalbumin levels, irrespective of the baseline estimated glomerular filtration rate. No changes in clinical parameters thought to indicate adverse events were noted. Conclusions: Glycoalbumin is an equivalent glycemic control indicator and predictor to hemoglobin A1c during linagliptin treatment. Linagliptin is safe and effective in diabetic patients with or without nephropathy.
Highlights
Dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used to treat diabetes because of their robust hypoglycemic effect and the minimal risks of hypoglycemia and weight gain [1]
Postprandial hyperglycemia, which is the cause of glycemic variability, is frequently observed in patients with uncontrolled diabetes, it has been reported in diabetes patients with intermediate Hemoglobin A1c (HbA1c) levels [3,4]
In the 69 patients with diabetic nephropathy (Figure 1c), HbA1c and GA levels decreased significantly at 3 and 6 months (HbA1c 8.2 ± 1.8% → 7.5 ± 1.5 → 7.6 ± 1.6 ; GA 23.1 ± 7.5% → 20.8 ± 5.3; → 21.2 ± 6.2; all P < 0.001 vs. baseline)
Summary
Dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used to treat diabetes because of their robust hypoglycemic effect and the minimal risks of hypoglycemia and weight gain [1]. As such, they occupy an important position in any diabetes treatment strategy. Some diabetes patients develop vascular complications despite relatively low HbA1c levels. Recent studies have suggested that vascular complications are caused by increased glycemic variability [2]. Postprandial hyperglycemia, which is the cause of glycemic variability, is frequently observed in patients with uncontrolled diabetes, it has been reported in diabetes patients with intermediate HbA1c levels [3,4]
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