DPP-4 Inhibitor Therapy in Patients after Pancreatic Transplant |
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| Affiliation: | 1. From the Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio.;2. Hypertension/Nephrology, Transplantation Center, Cleveland Clinic, Cleveland, Ohio.;3. Urology, Transplantation Center, Cleveland Clinic, Cleveland, Ohio.;4. Internal Medicine, Cleveland Clinic, Cleveland, Ohio.;1. From the Department of Physical Examination, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China;2. Division of Medical Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China;3. Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.;1. Department of Hematology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey;2. Department of Internal Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey;3. Department of Molecular Genetics, Ege University Faculty of Medicine, Izmir, Turkey;1. From the Northwest Pituitary Center and Departments of Medicine and Neurological Surgery, Oregon Health & Science University, Portland, Oregon;2. Department of Medicine, Stanford University School of Medicine, Stanford, California.;3. Department of Neurosurgery, Stanford University School of Medicine, Stanford, California.;1. Department of Histology and Embryology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovak Republic;2. Department of Neurology, Louis Pasteur University Hospital, Kosice, Slovak Republic;3. Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Italy;4. nd;5. Department of Gastroenterology, Central University Hospital of Asturias (HUCA) Oviedo, Asturias, Spain;6. International Clinical Research Center, St. Anne''s University Hospital and Masaryk University, Brno, Czech Republic |
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| Abstract: | Objective: Management of new onset hyperglycemia after pancreas transplantation (PT) is not well studied. There is a lack of information on effective and safe management options for hyperglycemia after PT. We tested the hypothesis that early intervention for hyperglycemia using a dipeptidyl peptidase-4 (DPP-4) inhibitor prolongs insulin-free graft function in patients after PT.Methods: Twenty-six patients who developed noninsulin-dependent hyperglycemia at least 1 year after PT met the inclusion criteria for this retrospective chart review. Sitagliptin, a DPP-4 inhibitor, was a commonly used therapy for hyperglycemia after PT due to its wide availability and coverage. The standard therapy group included patients who did not receive any oral or noninsulin injection therapy until insulin was clearly required to control hyperglycemia. The intervention group included patients who had received sitagliptin soon after hyperglycemia developed. The median follow-up period was 45 months. The time to hyperglycemia from 1 year after PT and time to insulin requirement after hyperglycemia development were compared between these 2 groups.Results: The time to hyperglycemia after PT was not different between the groups, but the time to insulin requirement was significantly longer in the intervention group compared with the standard therapy group (P<.001). After adjusting for body mass index (BMI), the difference remained significant (P<.001).Conclusion: Early treatment of hyperglycemia after PT with a DPP-4 inhibitor such as sitagliptin prolongs the time to insulin therapy compared with a standard observation approach. Prospective studies are needed to further investigate this observation.Abbreviations: BG = blood glucose BMI = body mass index CV = coefficient of variance DM = diabetes mellitus DPP-4 = dipeptidyl peptidase-4 HbA1c = glycated hemoglobin NODAT = new-onset diabetes after transplantation OHA = oral hypoglycemic agent PT = pancreas transplantation |
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