Adding Januvia to insulin-treated type 2 diabetes patients could have cardiovascular benefits

The addition of Januvia (sitagliptin) to insulin therapy could have benefits for adults with type 2 diabetes and no history of cardiovascular disease, a Japanese study finds. Januvia, the brand name for sitagliptin, is a DPP-IV inhibitor which is used to lower the blood glucose levels of people with type 2 diabetes. It can be taken alongside other medication, such as insulin. Researchers at Juntendo University Graduate School of Medicine, Tokyo, analysed data from 282 Japanese adults with type 2 diabetes. None of the participants had cardiovascular disease (CVD) and all were treated with insulin. They wanted to evaluate the effect of oral hypoglycemic agents on the progression of atherosclerosis, a condition which occurs when arteries become clogged up by fatty substances known as plaques. Atherosclerosis is a major risk factor for CVD. The participants were randomly allocated either to the sitagliptin group or a control group. In the drug group, patients took up to 100mg of sitagliptin once-daily. Patients in the control group either received increased insulin doses, or had a sulphonylurea, glinide, or alpha-glucosidase inhibitor added to their treatment. Echography was used to measure changes in mean and maximum intima-media thickness (IMT) of the common carotid artery (CCA) - which supplies blood to the head and neck - before the study and at 52 and 104 weeks. The IMT of the CCA is a marker of subclinical atherosclerosis and can increase with age. Sitagliptin reduced glucose levels more significantly than conventional treatment without increasing hypoglycemia or body weight, although the conventional treatment group also had lower HbA1c. Additionally, IMT changes were greater in the sitagliptin group: after 104 weeks, the sitagliptin group had significantly reduced mean and maximum ICT of the CCA compared to baseline. Discrepancies were noted between measurements of the left side of the CCA than the right, and the researchers wrote: "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. "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." The study was published in the online journal Diabetes Care.

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