[Efficacy of a DPP-4 inhibitor as assessed by continuous glucose monitoring (CGM)].

ABSTRACT

During the course of treatment with a DPP-4 inhibitor, 24-hour glycemic variations were assessed by continuous glucose monitoring to evaluate the magnitude of postprandial glycemic excursions as well as nighttime/late-night glycemic variations. The DPP-4 inhibitor given alone or in combination with a sulfonylurea (SU) reduced not only the 24-hour mean glucose level as equivalent to the HbAlc value but also the SD of 288 glucose levels for 24 hour and the mean amplitude glucose excursions (MAGE). Particularly, the DPP-4 inhibitor, when given in addition to SU, produces not only additive reductions in mean glucose levels but also reductions in the magnitude of glycemic variations, while at the same time exhibiting the potential to serve as a glucose modulator in low glucose levels. Furthermore, while monotherapy with a DPP-4 inhibitor improves postprandial hyperglycemia, combination therapy with a DPP-4 inhibitor and an alphaglucosidase inhibitor leads to additive improvements in postprandial hyperglycemia, thus exhibiting the potential to flatten the 24-hour glycemic variations. In summary, when assessed for its effects on 24-hour glycemic variations, the DPP-4 inhibitor produces reductions not only in the 24-hour mean glucose level but also in the magnitude of glycemic excursions, thus likely representing a new type of anti-diabetic agent that combines the merits of an SU, which potently lowers HbAlc primarily by reducing fasting glucose levels, and an alpha-glucosidase inhibitor, which reduces the magnitude of glycemic variations primarily by lowering postprandial glucose levels.