Vildagliptin, a dipeptidyl peptidase-IV inhibitor, improves model-assessed beta-cell function in patients with type 2 diabetes

A Mari, W M Sallas, Y L He, C Watson, M Ligueros-Saylan, B E Dunning, C F Deacon, Jens Juul Holst, J E Foley

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Abstract

AIMS/HYPOTHESIS: The dipeptidyl peptidase IV inhibitor, vildagliptin, increases levels of intact glucagon-like peptide-1 (GLP-1) and improves glycemic control in patients with type 2 diabetes. Although GLP-1 is known to stimulate insulin secretion, vildagliptin does not affect plasma insulin levels in diabetic patients, suggesting that more sophisticated measures are necessary to ascertain the influence of vildagliptin on beta-cell function.

METHODS: This study examined the effects of 28-d treatment with vildagliptin (100 mg, twice daily; n = 9) vs. placebo (n = 11) on beta-cell function in diabetic patients using a mathematical model that describes the insulin secretory rate as a function of glucose levels (beta-cell dose response), the change in glucose with time (derivative component), and a potentiation factor, which is a function of time and may reflect the actions of nonglucose secretagogues and other factors.

RESULTS: Vildagliptin significantly increased the insulin secretory rate at 7 mmol/liter glucose (secretory tone), calculated from the dose response; the difference in least squares mean (deltaLSM) was 101 +/- 51 pmol.min(-1).m(-2) (P = 0.002). The slope of the beta-cell dose response, the derivative component, and the potentiation factor were not affected. Vildagliptin also significantly decreased mean prandial glucose (deltaLSM, -1.2 +/- 0.4 mmol/liter; P = 0.01) and glucagon (deltaLSM, -10.7 +/- 4.8 ng/liter; P = 0.03) levels and increased plasma levels of intact GLP-1 (deltaLSM, +10.8 +/- 1.6 pmol/liter; P < 0.0001) and gastric inhibitory polypeptide (deltaLSM, +43.4 +/- 9.4 pmol/liter; P < 0.0001) relative to placebo.

CONCLUSION: Vildagliptin is an incretin degradation inhibitor that improves beta-cell function in diabetic patients by increasing the insulin secretory tone.

Original languageEnglish
JournalThe Journal of clinical endocrinology and metabolism
Volume90
Issue number8
Pages (from-to)4888-94
Number of pages7
ISSN0021-972X
DOIs
Publication statusPublished - Aug 2005

Keywords

  • Adamantane
  • Adenosine Deaminase Inhibitors
  • Adult
  • Blood Glucose
  • C-Peptide
  • Diabetes Mellitus, Type 2
  • Dipeptidyl Peptidase 4
  • Enzyme Inhibitors
  • Female
  • Glycoproteins
  • Humans
  • Insulin
  • Islets of Langerhans
  • Male
  • Middle Aged
  • Models, Biological
  • Nitriles
  • Pyrrolidines
  • Treatment Outcome

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