Abstract
BackgroundAlthough incretin therapy is clinically available in patients with type 2 diabetes undergoing hemodialysis, no study has yet examined whether incretin therapy is capable of maintaining glycemic control in this group of patients when switched from insulin therapy. In this study, we examined the efficacy of incretin therapy in patients with insulin-treated type 2 diabetes undergoing hemodialysis.MethodsTen type 2 diabetic patients undergoing hemodialysis received daily 0.3 mg liraglutide, 50 mg vildagliptin, and 6.25 mg alogliptin switched from insulin therapy on both the day of hemodialysis and the non-hemodialysis day. Blood glucose level was monitored by continuous glucose monitoring. After blood glucose control by insulin, patients were treated with three types of incretin therapy in a randomized crossover manner, with continuous glucose monitoring performed for each treatment.ResultsDuring treatment with incretin therapies, severe hyperglycemia and ketosis were not observed in any patients. Maximum blood glucose and mean blood glucose on the day of hemodialysis were significantly lower after treatment with liraglutide compared with treatment with alogliptin (p < 0.05), but not with vildagliptin. The standard deviation value, a marker of glucose fluctuation, on the non-hemodialysis day was significantly lower after treatment with liraglutide compared with treatment with insulin and alogliptin (p < 0.05), but not with vildagliptin. Furthermore, the duration of hyperglycemia was significantly shorter after treatment with liraglutide on both the hemodialysis and non-hemodialysis days compared with treatment with alogliptin (p < 0.05), but not with vildagliptin.ConclusionsThe data presented here suggest that patients with type 2 diabetes undergoing hemodialysis and insulin therapy could be treated with incretin therapy in some cases.
Highlights
Diabetes is a multifactorial progressive disease accompanied by subsequent systematic vascular complications
Intrinsic incretins are rapidly inactivated by Dipeptidyl peptidase-4 (DPP-4) [4], and as a result Glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase (DPP)-4 inhibitors have been developed for the treatment of type 2 diabetes
Continuous glucose monitoring continuous glucose monitoring (CGM) was performed during the last 2 days of insulin therapy as a baseline evaluation, and patients were treated with incretin therapy
Summary
Diabetes is a multifactorial progressive disease accompanied by subsequent systematic vascular complications. Medications that mimic or enhance incretin activity, such as glucagon-like peptide (GLP)-1 receptor agonists and dipeptidyl peptidase (DPP)-4 inhibitors, have emerged as important new treatments for type 2 diabetes [2]. Incretins, such as GLP-1 and glucose-dependent insulinotropic polypeptide (GIP), are secreted after meals and act directly on pancreatic β cells to stimulate glucose-dependent insulin secretion. Incretin therapy is clinically available in patients with type 2 diabetes undergoing hemodialysis, no study has yet examined whether incretin therapy is capable of maintaining glycemic control in this group of patients when switched from insulin therapy. We examined the efficacy of incretin therapy in patients with insulin-treated type 2 diabetes undergoing hemodialysis
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