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Comparison of Serum Ketone Levels and Cardiometabolic Efficacy of Dapagliflozin versus Sitagliptin among Insulin-Treated Chinese Patients with Type 2 Diabetes Mellitus.
Lee, Chi-Ho; Wu, Mei-Zhen; Lui, David Tak-Wai; Chan, Darren Shing-Hei; Fong, Carol Ho-Yi; Shiu, Sammy Wing-Ming; Wong, Ying; Lee, Alan Chun-Hong; Lam, Joanne King-Yan; Woo, Yu-Cho; Lam, Karen Siu-Ling; Yiu, Kelvin Kai-Hang; Tan, Kathryn Choon-Beng.
Afiliação
  • Lee CH; Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
  • Wu MZ; State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong, China.
  • Lui DT; Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
  • Chan DS; Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
  • Fong CH; Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
  • Shiu SW; Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
  • Wong Y; Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
  • Lee AC; Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
  • Lam JK; Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
  • Woo YC; Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
  • Lam KS; Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
  • Yiu KK; Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
  • Tan KC; State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong, China.
Diabetes Metab J ; 46(6): 843-854, 2022 11.
Article em En | MEDLINE | ID: mdl-35483674
BACKGROUND: Insulin-treated patients with long duration of type 2 diabetes mellitus (T2DM) are at increased risk of ketoacidosis related to sodium-glucose co-transporter 2 inhibitor (SGLT2i). The extent of circulating ketone elevation in these patients remains unknown. We conducted this study to compare the serum ketone response between dapagliflozin, an SGLT2i, and sitagliptin, a dipeptidyl peptidase-4 inhibitor, among insulin-treated T2DM patients. METHODS: This was a randomized, open-label, active comparator-controlled study involving 60 insulin-treated T2DM patients. Participants were randomized 1:1 for 24-week of dapagliflozin 10 mg daily or sitagliptin 100 mg daily. Serum ß-hydroxybutyrate (BHB) levels were measured at baseline, 12 and 24 weeks after intervention. Comprehensive cardiometabolic assessments were performed with measurements of high-density lipoprotein cholesterol (HDL-C) cholesterol efflux capacity (CEC), vibration-controlled transient elastography and echocardiography. RESULTS: Among these 60 insulin-treated participants (mean age 58.8 years, diabetes duration 18.2 years, glycosylated hemoglobin 8.87%), as compared with sitagliptin, serum BHB levels increased significantly after 24 weeks of dapagliflozin (P=0.045), with a median of 27% increase from baseline. Change in serum BHB levels correlated significantly with change in free fatty acid levels. Despite similar glucose lowering, dapagliflozin led to significant improvements in body weight (P=0.006), waist circumference (P=0.028), HDL-C (P=0.041), CEC (P=0.045), controlled attenuation parameter (P=0.007), and liver stiffness (P=0.022). Average E/e', an echocardiographic index of left ventricular diastolic dysfunction, was also significantly lower at 24 weeks in participants treated with dapagliflozin (P=0.037). CONCLUSION: Among insulin-treated T2DM patients with long diabetes duration, compared to sitagliptin, dapagliflozin modestly increased ketone levels and was associated with cardiometabolic benefits.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doenças Cardiovasculares / Diabetes Mellitus Tipo 2 / Inibidores do Transportador 2 de Sódio-Glicose Tipo de estudo: Clinical_trials / Risk_factors_studies Limite: Humans / Middle aged País/Região como assunto: Asia Idioma: En Revista: Diabetes Metab J Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doenças Cardiovasculares / Diabetes Mellitus Tipo 2 / Inibidores do Transportador 2 de Sódio-Glicose Tipo de estudo: Clinical_trials / Risk_factors_studies Limite: Humans / Middle aged País/Região como assunto: Asia Idioma: En Revista: Diabetes Metab J Ano de publicação: 2022 Tipo de documento: Article