Sitagliptin in Glutamic Acid Decarboxylase Antibody-Positive Diabetes Mellitus |
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| Affiliation: | 1. Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science;2. Department of Neurology;3. Department of Clinical Immunology, Addenbrooke’s Hospital, Cambridge University Hospitals National Health Service Trust, Cambridge, United Kingdom.;1. Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, 10000 Zagreb, Croatia;2. University of Zagreb, School of Medicine, 10000 Zagreb, Croatia;3. Rudjer Boskovic Institute, Division of Molecular Medicine, Laboratory for Molecular Neuropsychiatry, 10000 Zagreb, Croatia;1. College of Medicine, Tzu Chi University, Hualien, Taiwan;2. Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan;3. Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan;4. College of Medicine, China Medical University, Taichung, Taiwan;5. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan;6. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan;7. Department of Urology, China Medical University Hospital, Taichung, Taiwan |
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| Abstract: | ObjectiveTo describe a case illustrating the use of sitagliptin, an inhibitor of dipeptidyl-peptidase-4 (DPP-4), in anti-glutamic acid decarboxylase antibody-positive diabetes mellitus in association with a rare ataxic variant of stiff person syndrome.MethodsWe present our experience with use of the DPP-4 inhibitor sitagliptin for management of autoimmune diabetes in a elderly woman and highlight the association of diabetes with other autoimmune conditions.ResultsA 68-year-old Japanese woman presented with poorly controlled “type 2” diabetes mellitus, cerebral palsy, cerebellar ataxia, and hypothyroidism. She complained of stiffness and spasms, which had resulted in multiple falls and immobility. Antidiabetic medications included gliclazide, rosiglitazone, and acarbose; various insulins had been tried but discontinued because they worsened her stiffness and spasms. Her hemoglobin A1c values remained above 9% despite maximal doses of the aforementioned orally administered hypoglycemic agents. After sitagliptin therapy was initiated, her hemoglobin A1c level decreased from 9.3% (78 mmol/mol) to 7.3% (56 mmol/mol) in 5 months. Investigations confirmed the presence of an ataxic variant of stiff person syndrome. On repeated testing 18 months later, her anti-glutamic acid decarboxylase antibody levels had declined by more than 85%.ConclusionApart from the well-known mechanism of an increase in glucagonlike peptide-1, sitagliptin may exert its glucose-lowering effect by other mechanisms in patients with autoimmune diabetes. Further studies should be undertaken to address the effectiveness of DPP-4 inhibitors in non-type 2 diabetes. (Endocr Pract. 2012;18: e65-e68) |
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