Abstract
IntroductionA high hemoglobin glycation index (HGI) and glycated hemoglobin (HbA1c) level are associated with greater inflammatory status, and dipeptidyl peptidase-4 (DPP-4) inhibitors can suppress inflammation. We aimed to evaluate the relationship between HGI and the therapeutic effect of DPP-4 inhibitors.MethodsThis retrospective cohort study followed 468 patients with type 2 diabetes receiving DPP-4 inhibitor treatment for 1 year. Estimated HbA1c was calculated using a linear regression equation derived from another 2969 randomly extracted patients with type 2 diabetes based on fasting plasma glucose (FPG) level. The subjects were divided into two groups based on HGI (HGI = observed HbA1c - estimated HbA1c). Mixed model repeated measures were used to compare the treatment efficacy after 1 year in patients with a low (HGI<0, n = 199) and high HGI (HGI≧0, n = 269).ResultsThere were no significant group differences in mean changes of FPG after 1 year (-12.8 and -13.4 mg/dL in the low and high HGI groups, respectively). However, the patients with a high HGI had a significantly greater reduction in HbA1c from baseline compared to those with a low HGI (-1.9 versus -0.3% [-20.8 versus -3.3 mmol/mol]). Improvements in glycemic control were statistically significantly associated with the tested DPP-4 inhibitors in the high HGI group (-2.4, -1.4, -1.2 and -2.2% [-26.2, -15.3, -13.1 and -24.0 mmol/mol] for vildagliptin, linagliptin, saxagliptin and sitagliptin, respectively) but not in the low HGI group.ConclusionsThe HGI index derived from FPG and HbA1c may be able to identify who will have a better response to DPP-4 inhibitors.
Highlights
ObjectivesWe aimed to evaluate the relationship between hemoglobin glycation index (HGI) and the therapeutic effect of dipeptidyl peptidase-4 (DPP-4) inhibitors
A high hemoglobin glycation index (HGI) and glycated hemoglobin (HbA1c) level are associated with greater inflammatory status, and dipeptidyl peptidase-4 (DPP-4) inhibitors can suppress inflammation
Improvements in glycemic control were statistically significantly associated with the tested DPP-4 inhibitors in the high HGI
Summary
We aimed to evaluate the relationship between HGI and the therapeutic effect of DPP-4 inhibitors. Based on the potential anti-inflammatory effects of DPP-4 inhibitors and as individuals with a high HGI have a higher inflammatory status, we hypothesized that diabetic patients receiving DPP-4 inhibitors may exhibit diverse therapeutic outcomes associated with the initial HGI status. This study aimed to examine this hypothesis
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