Juan Camilo Arjona Ferreira, MD, of Merck in Rahway, N.J., and colleagues treated patients who had type 2 diabetes and end-stage renal disease (ESRD) with two different drugs: sitagliptin and glipizide. 30% of all patients saw an improvement of A1C haemoglobin, and 6.5% of which did so after only a year’s treatment of either drugs. Over time, the researchers noted that the two drugs maintained similar control during 54 weeks of follow-up, but patients who were treated with glipizide had a tendency to gain weight. Those treated with sitagliptin, on the other hand, had actually achieved some weight loss.
Diabetes is the leading cause of ESRD and previous studies have demonstrated that patient outcomes can be improved with good glycaemic control. However, if you have type 2 diabetes and you’re on dialysis, you have fewer therapeutic options to control your diabetes as some agents aren’t advisable for patients with impaired kidney function, hence the reason for the study.
However, neither group was devoid of negative side effects. The rate was similar in both groups, though drug-related adverse events occurred slightly more often in the glipizide arm of the study. 16-18% of patients experienced serious adverse events and about 8% of patients in both groups discontinued treatment because of these side effects. In a small proportion of patients in both groups, there were occurrences of serious cardiovascular and heart failure events.
The investigators concluded that ‘In patients with type 2 diabetes and ESRD on dialysis, treatment with sitagliptin 25 mg once daily for 54 weeks provides clinically meaningful reductions from baseline in A1c and fasting plasma glucose, similar to those observed with glipizide’ but sitagliptin wins out by the fact that it ‘is generally well tolerated, with a numerically lower incidence of symptomatic hypoglycaemia and a lower incidence of severe episodes of hypoglycaemia than glipizide. Sitagliptin results in a trend toward weight loss compared with weight gain with glipizide.’