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The effect of alogliptin and pioglitazone combination therapy on various aspects of β-cell function in patients with

Daniël H Van Raalte1, Renate E van Genugten, Björn Eliasson

  • 1Diabetes Center, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.

European Journal of Endocrinology
|January 15, 2014
PubMed
Abstract

Insights

Initial combination therapy with alogliptin and pioglitazone improved glycemic control and beta-cell function in type 2 diabetes mellitus (T2DM). This combination therapy offers a sensible approach to addressing multiple core defects in T2DM management.

Area of Science:

  • Endocrinology
  • Pharmacology
  • Metabolic Diseases

Background:

  • Type 2 diabetes mellitus (T2DM) management necessitates treatment intensification due to progressive beta-cell dysfunction.
  • Insulin resistance is a key factor in T2DM progression.
  • Initial combination therapy with a dipeptidyl peptidase (DPP)-4 inhibitor and a thiazolidinedione (TZD) is a potential therapeutic strategy.

Purpose of the Study:

  • To assess the effects of alogliptin (ALO) combined with pioglitazone (PIO) versus ALO monotherapy or placebo (PBO) on beta-cell function and glycemic control in T2DM patients.
  • To evaluate the efficacy of dual combination therapy in addressing core defects of T2DM.

Main Methods:

  • A 16-week, randomized, double-blind, placebo-controlled study involving 71 T2DM patients on existing monotherapy.
  • Patients received either ALO 25 mg + PIO 30 mg daily, ALO 25 mg daily, or placebo.
  • Primary outcomes included changes in A1C and fasting plasma glucose (FPG); secondary outcomes assessed beta-cell function parameters via standardized meal tests.

Main Results:

  • Both ALO/PIO and ALO significantly decreased A1C compared to placebo (P<0.001).
  • ALO/PIO demonstrated a greater reduction in FPG compared to ALO monotherapy (P<0.01).
  • ALO/PIO significantly improved beta-cell glucose sensitivity and fasting secretory tone (P<0.001 and P=0.001, respectively), while ALO monotherapy did not alter beta-cell function.

Conclusions:

  • Short-term treatment with ALO/PIO or ALO improved glycemic control in T2DM patients.
  • Only the combination of ALO/PIO significantly improved beta-cell function.
  • Initial combination therapy with a DPP-4 inhibitor and TZD is a rational approach for managing T2DM by targeting multiple underlying defects.

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