Abstract
BackgroundIncretin therapy is feasible in patients with type 2 diabetes mellitus undergoing hemodialysis (HD). However, few studies have examined the safety and efficacy of this therapeutic approach in patients with diabetes and renal impairment. Here, we examined glycemic control and the anti-oxidative-stress effects of the dipeptidyl peptidase (DPP)-4 inhibitor linagliptin in patients with type 2 diabetes undergoing HD.MethodsThirty-five patients with type 2 diabetes undergoing HD (including 13 insulin-treated patients) were switched from ongoing therapy to linagliptin (5 mg, once daily). Levels of fasting blood glucose, C-peptide immunoreactivity (CPR), glycated albumin, B-type natriuretic peptide, oxidized low-density lipoprotein (oxLDL), high-sensitivity C-reactive protein, 8-hydroxy-2′-deoxyguanosine (8OHdG), body mass index, blood pressure, and other biologic characteristics (liver function, renal function, lipid profile) were determined before and 3 months after linagliptin treatment. Patients were classified into insulin-treated and non-insulin groups.ResultsWith the exception of levels of total bilirubin, aspartate aminotransferase, and CPR, none of the patients exhibited changes in glucose metabolism after switching to linagliptin treatment. However, oxLDL levels were decreased significantly by linagliptin therapy in the non-insulin-treated group despite the absence of changes in glycemic control.ConclusionLinagliptin can decrease serum levels of oxLDL in patients with type 2 diabetes undergoing HD independent of its glucose-lowering effect.
Highlights
Incretin therapy is feasible in patients with type 2 diabetes mellitus undergoing hemodialysis (HD)
No episodes of severe hyperglycemia, ketosis, severe nausea, or other adverse effects were observed in patients at any time during linagliptin treatment
Serum levels of Aspartate aminotransferase (AST) and total bilirubin were decreased significantly by linagliptin treatment, but these changes were within the normal range and not clinically significant
Summary
Incretin therapy is feasible in patients with type 2 diabetes mellitus undergoing hemodialysis (HD). We examined glycemic control and the anti-oxidative-stress effects of the dipeptidyl peptidase (DPP)-4 inhibitor linagliptin in patients with type 2 diabetes undergoing HD. Controlling glucose levels in the blood of diabetic patients with severe renal failure is difficult because of: frequent hypoglycemia; restrictions in the use of anti-. We have reported the efficacy of incretin therapy using continuous monitoring of glucose in patients with type 2 diabetes undergoing HD [1]. Lowering the glomerular filtration rate in patients with chronic kidney disease increases oxidative stress [2]. This action increases the risk of cardiovascular disease, primarily through inactivation of nitric oxide and production of oxidized low-density lipoprotein (oxLDL) [3]. Patients with type 2 diabetes undergoing HD must be administered
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