Use of Sitagliptin With Closed-Loop Technology to Decrease Postprandial Blood Glucose in Type 1 Diabetes.

Area of Science:

• Endocrinology
• Metabolic Diseases
• Pharmacology

Background:

• Postprandial hyperglycemia presents a significant challenge for automated insulin delivery systems.
• Dipeptidyl peptidase-4 (DPP-4) inhibitors, such as sitagliptin, are known to lower postprandial glucose in type 2 diabetes.
• The efficacy of sitagliptin as an adjunct therapy in type 1 diabetes (T1DM) within closed-loop systems requires investigation.

Purpose of the Study:

• To evaluate the role of sitagliptin as an adjunctive treatment in T1DM.
• To assess sitagliptin's effectiveness in reducing postprandial blood glucose levels within an insulin-only closed-loop system.

Main Methods:

• A randomized, double-blinded, placebo-controlled, crossover trial was conducted.
• Two studies were performed: a dose-determination study and a 25-hour closed-loop system study.
• Participants with T1DM (age 18-35, HbA1c ≤ 8.5%) received either sitagliptin (50 or 100 mg) or placebo before mixed meal tolerance tests and during closed-loop system monitoring.

Main Results:

• Sitagliptin at 100 mg significantly reduced postprandial blood glucose in the dose-determination phase (P = .006).
• In the closed-loop study, glucose concentrations were significantly lower with sitagliptin, particularly during the first two meals (P = .03).
• Sitagliptin treatment led to reduced insulin concentrations and delivery, with no significant change in glucagon levels.

Conclusions:

• Sitagliptin demonstrates potential as an adjunct therapy to mitigate postprandial hyperglycemia in closed-loop systems for T1DM.
• Further research with larger cohorts is necessary to fully establish the role of oral agents like sitagliptin in conjunction with closed-loop systems.