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LETTER TO THE EDITOR
Year : 2012  |  Volume : 16  |  Issue : 6  |  Page : 1048

Evaluation of vildagliptin and fixed dose combination of vildagliptin and metformin on glycemic control and insulin dose over three months in patients with type 2 diabetes mellitus'


Department of Internal Medicine, St. John Medical Center, Tulsa, USA

Date of Web Publication31-Oct-2012

Correspondence Address:
Vishal Mundra
SJP Hospitalist, 1705 E. 19th St., Holliman Building, Suite 302, Tulsa, OK 74104,
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.103040

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How to cite this article:
Mundra V. Evaluation of vildagliptin and fixed dose combination of vildagliptin and metformin on glycemic control and insulin dose over three months in patients with type 2 diabetes mellitus'. Indian J Endocr Metab 2012;16:1048

How to cite this URL:
Mundra V. Evaluation of vildagliptin and fixed dose combination of vildagliptin and metformin on glycemic control and insulin dose over three months in patients with type 2 diabetes mellitus'. Indian J Endocr Metab [serial online] 2012 [cited 2019 Dec 16];16:1048. Available from: http://www.ijem.in/text.asp?2012/16/6/1048/103040

Sir,

This letter is in response to the interesting study published by Ved and Shah titled - 'Evaluation of vildagliptin and fixed dose combination of vildagliptin and metformin on glycemic control and insulin dose over three months in patients with type 2 diabetes mellitus'.

Incretin based therapy are the new effective innovation in the treatment of diabetes. We thank Dr. Paresh Ved and Dr. Samrat Shah for sharing the finding of this multicenter study with us but this study raised a few questions which were left unanswered. First of all, how many patients received vildagliptin vs FDC combination of vildagliptin and metformin? Secondly, how was the dose titrated upwards for them? Did the clinician follow a protocol across all the centers? Was there a significant difference in HbA1c drop/FPG/PPG change in all the three groups? Also, they reported weight loss as one of the benefit of using DPP-IV inhibitors. In a recent meta-analysis [1] and a randomized trial [2] they have been found to be weight neutral. If the weight change associated with concurrent metformin use, was not clarified in the study. Lastly, there were no comments on the adverse events seen in each group separately.

As the authors mentioned, elderly patient may be better candidate for such therapy as they have lower risk of hypoglycemia. [3] However, they also tend to have higher incidence of renal dysfunction which requires very careful selection. This study supports the findings that both drugs execute complimentary actions achieving better glycemic control. [4],[5] Recently FDA also approved use of exenatide in combination with long acting insulin based on a study published by Buse et al. [6]

We definitely need more randomized trials to further elucidate the role of DPP-IV inhibitors and their benefit in terms of cardiac, lipids and insulin sensitivity as mentioned by the authors.

 
   References Top

1.Amori RE, Lau J, Pittas AG. Efficacy and safety of incretin therapy in type 2 diabetes: Systematic review and meta-analysis. JAMA 2007;298:194-206.  Back to cited text no. 1
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2.Goldstein BJ, Feinglos MN, Lunceford JK, Johnson J, Williams-Herman DE, Sitagliptin 036 Study Group. Effect of initial combination therapy with sitagliptin, a dipeptidyl peptidase-4 inhibitor, and metformin on glycemic control in patients with type 2 diabetes. Diabetes Care 2007;30:1979-87.  Back to cited text no. 2
    
3.Schwartz SL. Treatment of elderly patients with type 2 diabetes mellitus: A systematic review of the benefits and risks of dipeptidyl peptidase-4 inhibitors. Am J Geriatr Pharmacother 2010;8:405-18.  Back to cited text no. 3
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4.Scheen AJ. DPP-4 inhibitors in the management of type 2 diabetes: A critical review of head-to-head trials. Diabetes Metab 2012;38:89-101.  Back to cited text no. 4
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5.Scheen AJ. Metformin + saxagliptin for type 2 diabetes. Expert Opin Pharmacother 2012;13:139-46.  Back to cited text no. 5
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6.Buse JB, Bergenstal RM, Glass LC, Heilmann CR, Lewis MS, Kwan AY, et al. Use of twice-daily exenatide in Basal insulin-treated patients with type 2 diabetes: A randomized, controlled trial. Ann Intern Med 2011;154:103-12.  Back to cited text no. 6
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This article has been cited by
1 Evaluation of vildagliptin and fixed dose combination of vildagliptin and metformin on glycemic control and insulin dose over 3 months in patients with type 2 diabetes mellitus
Paresh Ved,Samrat Shah
Indian Journal of Endocrinology and Metabolism. 2013; 17(1): 178
[Pubmed] | [DOI]



 

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