Efficacy of switching from premix analog insulin twice daily injection to insulin glargine once daily injection with sitagliptin

Forty-four patients with type 2 diabetes receiving twice daily injections of premix analog insulin were randomly allocated to Group A in which patients were switched to long-acting insulin glargine at 80 % of the insulin dose in the previous treatment regimen (23 patients), or Group B (21 patients) given 50 % of the previous dose, concurrently with the oral dipeptidyl-4 inhibitor sitagliptin. After patients had received their designated treatments without dose changes for 12 weeks, the insulin dose was adjusted and its usefulness was examined for 24 weeks. In the overall evaluation, significant improvement was observed in glycosylated hemoglobin (HbA1c), 1,5-anhydro-d-glucitol, fasting blood glucose, and low density lipoprotein cholesterol levels. The insulin glargine dose at 24 weeks was 65.0 % of the mixed formulation used in the previous treatment regimen. Although no significant change was observed in HbA1c levels in Group B during the study period, the level of 1,5-anhydro-d-glucitol increased significantly, while continuous glucose monitoring also showed improvement in postprandial hyperglycemia and nocturnal hypoglycemia. The change from baseline in HbA1c levels during the 24 weeks showed a significant negative correlation with C-peptide levels at the start of treatment, suggesting the usefulness of this regimen, particularly in patients maintaining endogenous insulin secretion capacity.