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Comparison of vildagliptin twice daily vs. sitagliptin once daily using continuous glucose monitoring (CGM): Crossover pilot study (J-VICTORIA study) Full Text
Cardiovascular Diabetology, 08/09/2012
Clinical Article
Sakamoto M et al. – Continuous glucose monitoring (CGM) showed that mean 24–hour blood glucose, mean amplitude of glycemic excursions (MAGE), highest blood glucose level after supper, and hyperglycemia after breakfast were significantly lower in patients with type 2 diabetes mellitus taking vildagliptin than those taking sitagliptin. There were no significant differences in brain natriuretic peptide (BNP) and plasminogen activator inhibitor–1 (PAI–1) levels between patients taking vildagliptin and sitagliptin.
Methods- Twenty patients with type 2 diabetes mellitus were randomly allocated to groups who received vildagliptin then sitagliptin, or vice versa.
- Patients were hospitalized at 1 month after starting each drug, and CGM was used to determine:
- 1) mean (+/– standard deviation) 24–hour blood glucose level,
- 2) mean amplitude of glycemic excursions (MAGE),
- 3) fasting blood glucose level,
- 4) highest postprandial blood glucose level and time,
- 5) increase in blood glucose level after each meal,
- 6) area under the curve (AUC) for blood glucose level [greater than or equal to]180 mg/dL within 3 hours after each meal,
- 7) area over the curve (AOC) for daily blood glucose level <70 mg/dL.
- Plasma glycosylated hemoglobin (HbA1c), glycoalbumin (GA), 1,5–anhydroglucitol (1,5AG), immunoreactive insulin (IRI), C–peptide immunoreactivity (CPR), brain natriuretic peptide (BNP), and plasminogen activator inhibitor–1 (PAI–1) levels, and urinary CPR levels, were measured.
- The mean 24–hour blood glucose level was significantly lower in patients taking vildagliptin than sitagliptin (142.1 +/– 35.5 vs. 153.2 +/– 37.0 mg/dL; p = 0.012).
- In patients taking vildagliptin, MAGE was significantly lower (110.5 +/– 33.5 vs. 129.4 +/– 45.1 mg/dL; p = 0.040), the highest blood glucose level after supper was significantly lower (206.1 +/– 40.2 vs. 223.2 +/– 43.5 mg/dL; p = 0.015), the AUC ([greater than or equal to]180 mg/dL) within 3 hours was significantly lower after breakfast (484.3 vs. 897.9 mg/min/dL; p = 0.025), and urinary CPR level was significantly higher (97.0 +/– 41.6 vs. 85.2 +/– 39.9 mug/day; p = 0.008) than in patients taking sitagliptin.
- There were no significant differences in plasma HbA1c, GA, 1,5AG, IRI, CPR, BNP, or PAI–1 levels between patients taking vildagliptin and sitagliptin.
