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Januvia reduces carotid intima-media thickness in insulin-treated type 2 diabetes
In adults with type 2 diabetes and no history of cardiovascular disease, the addition of the DPP-IV inhibitor Januvia to insulin therapy resulted in significant regression of carotid intima-media thickness after 2 years, according to research in Diabetes Care.
Tomoya Mita, MD, PhD, of Juntendo University Graduate School of Medicine in Tokyo, and colleagues analyzed data from 282 Japanese adults with type 2 diabetes and no CVD history who were prescribed insulin. Researchers randomly assigned participants up to 100 mg once-daily Januvia (sitagliptin, Merck; n = 142; 83 men; mean age, 64 years; mean duration of diabetes, 17.2 years) or conventional treatment that included increasing the dose of insulin or adding a sulfonylurea, glinide or alpha-glucosidase inhibitor (n = 140; 82 men; mean age, 64 years; mean duration of diabetes, 17.3 years) for 104 weeks. Echography was used to measure changes in mean and maximum intima-media thickness (IMT) of the common carotid artery (CCA) at baseline, 52 weeks and 104 weeks.
In the mixed-effects model for repeated measures, sitagliptin, compared with conventional treatment, slowed the worsening of mean IMT-CCA (–0.029 mm vs. 0.024 mm; P = .005) and left maximum IMT-CCA (–0.065 mm vs. 0.022 mm; P = .021) at 104 weeks, but not right maximum IMT-CCA (–0.007 mm vs. 0.027 mm; P = .45). Findings persisted after adjustment for age, sex, BMI, HbA1c, lipid profile, smoking status and use of angiotensin-converting enzyme and angiotensin II receptor blocker inhibitors.
Although participants in both groups saw a reduction in HbA1c, sitagliptin had a greater glucose-lowering effect than conventional treatment (–0.5% vs. –0.2%; P = .004).
No significant between-group differences were observed in adverse events (65 in sitagliptin group vs. 58 in conventional group) or serious adverse events (eight in sitagliptin group vs. nine in conventional group).
The researchers noted that maximum IMT-CCA is more accurately measured on the left side than the right side, as the left wall is thicker and more elastic.
“Because of these discrepant results (between left and right maximum IMT-CCA), it might be viewed as an exaggeration if we were to conclude that sitagliptin attenuates the progression of carotid IMT,” the researchers wrote. “However ... the positive results for the mean IMT-CCA and left maximum IMT-CCA are more reliable than the negative result on the right maximum IMT-CCA, which could be a result of the underpowered sample.” – by Regina Schaffer
Disclosure: Mita reports receiving research funds from Merck Sharp & Dohme and Takeda Pharmaceutical, and lecture fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Kowa Pharmaceutical, Mitsubishi Tanabe Pharma, Merck Sharp & Dohme, Ono Pharmaceutical and Takeda Pharmaceutical. Please see the full study for the other study authors’ relevant financial disclosures.