TY - JOUR

T1 - Short-term renal and metabolic effects of low dose vildagliptin treatment added-on insulin therapy in non-proteinuric patients with type 2 diabetes

T2 - Open-label randomized prospective study

AU - Bayrasheva, Valentina K.

AU - Pchelin, Ivan Y.

AU - Dobronravov, Vladimir A.

AU - Babenko, Alina Yu

AU - Chefu, Svetlana G.

AU - Shatalov, Ivan S.

AU - Vasilkova, Volha N.

AU - Hudiakova, Natalia V.

AU - Ivanova, Alexandra N.

AU - Andoskin, Pavel A.

AU - Grineva, Elena N.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Objective: The aim of this randomized comparative study was to assess renal and metabolic effects of vildagliptin in insulin-treated type 2 diabetes (T2DM) patients without overt chronic kidney disease. Subjects and methods: We randomized 47 insulin-treated non-proteinuric patients with satisfactory controlled T2DM and estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73m2 either to continue insulin therapy (control) or to receive combined insulin-vildagliptin treatment (VIG group). We assessed eGFR using serum creatinine (eGFRcreat), cystatin C (eGFRcys), and both (eGFRcreat-cys), and urinary creatinine-adjusted excretion of albumin (UACR), type IV collagen (uCol IV/Cr), and neutrophil gelatinase-associated lipocalin (uNGAL/Cr) at baseline and after 6 months of treatment. Results: Study groups were comparable in terms of age and sex (60.1 ± 6.1 years and 42.9% men in control group vs. 60.8 ± 5.2 years and 39.1% in VIG group). After 6 months of treatment, there were no significant changes in main assessed parameters in control group. VIG group demonstrated significant decrease in HbA1c, diastolic blood pressure, frequency of hypoglycemia, and high-sensitivity C-reactive protein level as compared to the changes in control group. While eGFRcreat, UACR, and uNGAL/Cr showed no significant changes after vildagliptin addition, eGFRcys, eGFRcreat-cys, and uCol IV/Cr changed significantly in comparison with control group (+7.0% [3.7;13.3]; +5.1% [1.4;8.5];-32,8% [-55.8;-24.4], respectively, p < 0.01 each). Correlation and regression analysis revealed glucose-independent pattern of these changes. Conclusion: Addition of vildagliptin to ongoing insulin therapy in patients with T2DM was associated with a reduction in uCol IV/Cr and an increase in eGFRcys and eGFRcreat-cys, independent of T2DM control parameters.

AB - Objective: The aim of this randomized comparative study was to assess renal and metabolic effects of vildagliptin in insulin-treated type 2 diabetes (T2DM) patients without overt chronic kidney disease. Subjects and methods: We randomized 47 insulin-treated non-proteinuric patients with satisfactory controlled T2DM and estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73m2 either to continue insulin therapy (control) or to receive combined insulin-vildagliptin treatment (VIG group). We assessed eGFR using serum creatinine (eGFRcreat), cystatin C (eGFRcys), and both (eGFRcreat-cys), and urinary creatinine-adjusted excretion of albumin (UACR), type IV collagen (uCol IV/Cr), and neutrophil gelatinase-associated lipocalin (uNGAL/Cr) at baseline and after 6 months of treatment. Results: Study groups were comparable in terms of age and sex (60.1 ± 6.1 years and 42.9% men in control group vs. 60.8 ± 5.2 years and 39.1% in VIG group). After 6 months of treatment, there were no significant changes in main assessed parameters in control group. VIG group demonstrated significant decrease in HbA1c, diastolic blood pressure, frequency of hypoglycemia, and high-sensitivity C-reactive protein level as compared to the changes in control group. While eGFRcreat, UACR, and uNGAL/Cr showed no significant changes after vildagliptin addition, eGFRcys, eGFRcreat-cys, and uCol IV/Cr changed significantly in comparison with control group (+7.0% [3.7;13.3]; +5.1% [1.4;8.5];-32,8% [-55.8;-24.4], respectively, p < 0.01 each). Correlation and regression analysis revealed glucose-independent pattern of these changes. Conclusion: Addition of vildagliptin to ongoing insulin therapy in patients with T2DM was associated with a reduction in uCol IV/Cr and an increase in eGFRcys and eGFRcreat-cys, independent of T2DM control parameters.

KW - Cystatin C

KW - NGAL

KW - Renal function

KW - Type 2 diabetes

KW - Type IV collagen

KW - Vildagliptin

KW - cystatin C

KW - type IV collagen

KW - IV

KW - NEPHROPATHY

KW - BLOOD-PRESSURE

KW - VARIABILITY

KW - GLOMERULAR-FILTRATION-RATE

KW - type 2 diabetes

KW - CYSTATIN-C

KW - CREATININE

KW - HYPOGLYCEMIA

KW - renal function

KW - CHRONIC KIDNEY-DISEASE

KW - ASSOCIATION

UR - http://www.scopus.com/inward/record.url?scp=85089768284&partnerID=8YFLogxK

UR - https://www.mendeley.com/catalogue/8899fa9a-41ba-338d-a0af-cae837ffc379/

U2 - 10.20945/2359-3997000000220

DO - 10.20945/2359-3997000000220

M3 - Article

C2 - 32267348

AN - SCOPUS:85089768284

VL - 64

SP - 418

EP - 426

JO - Archives of endocrinology and metabolism

JF - Archives of endocrinology and metabolism

SN - 2359-3997

IS - 4

ER -