Lowering of postprandial lipids in individuals with type 2 diabetes treated with alogliptin and/or pioglitazone: a randomised double-blind placebo-controlled study.

Abstract

AIMS/HYPOTHESIS:

Pharmacological augmentation of glucagon-like peptide 1 receptor signalling by dipeptidyl peptidase 4 (DPP-4) inhibition reduced intestinal lipoprotein secretion in experimental studies, suggesting that DPP-4 inhibitors may ameliorate dyslipidaemia and thus reduce cardiovascular risk in patients with type 2 diabetes. We assessed the effects of alogliptin (Alo) and Alo co-administered with pioglitazone (Pio) vs placebo (Pbo) on triacylglycerol (TG)-rich lipoproteins in type 2 diabetes before and following a high-fat meal.

METHODS:

Seventy-one patients (age 18-70 years), who did not reach HbA(1c) 6.5% (48 mmol/mol) with lifestyle and/or metformin, sulfonylurea or glinide therapy, participated in this 16 week, double-centre (university hospitals) Pbo-controlled parallel-group study. All participants, people doing measurements or examinations, and people assessing the outcomes were blinded to group assignment. Fasting TG 1.7-5.0 mmol/l was among the entry criteria. Patients received a high-fat mixed meal before and 4 and 16 weeks after randomisation (allocation by central office) to Alo (n = 25), Alo/Pio (n = 22) or Pbo (n = 24). Blood was sampled at pre-specified intervals, starting at 15 min before and ending 8 h after meal ingestion.

RESULTS:

At week 16, Alo (n = 25) and Alo/Pio (n = 21) vs Pbo (n = 24) produced similar significant reductions in total postprandial TG response (incremental AUC [iAUC]; p < 0.001), as well as in chylomicron TG (p < 0.001) and VLDL1 TG iAUCs (p < 0.001 and p = 0.012, respectively). Postprandial chylomicron apolipoprotein B-48 iAUC showed a significant decrease after Alo treatment (p = 0.028), and a non-significant trend towards a decrease with Alo/Pio (p = 0.213). The incidence of adverse events was low and consistent with previous studies.

CONCLUSIONS/INTERPRETATION:

Treatment with Alo and Alo/Pio produced significant reductions in postprandial TG and TG-rich lipoproteins, contributing to an improved overall cardiometabolic risk profile in type 2 diabetes. The data support the concept that incretins not only modulate glucose metabolism but also influence chylomicron metabolism in intestinal cells.

TRIAL REGISTRATION:

ClinicalTrials.gov number NCT00655863.

• Authors: B Eliasson, D Möller-Goede, K Eeg-Olofsson, C Wilson, J Cederholm, P Fleck, M Diamant, M-R Taskinen, U Smith
• Journal: Diabetologia (Diabetologia) Vol. 55 Issue 4 Pg. 915-25 (Apr 2012) ISSN: 1432-0428 [Electronic] Germany
• PMID: 22237690 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Blood Glucose
• Dipeptidyl-Peptidase IV Inhibitors
• Hypoglycemic Agents
• Insulin
• Lipids
• Piperidines
• Thiazolidinediones
• Uracil
• alogliptin
• Pioglitazone

Topics

• Adult
• Aged
• Blood Glucose
• Diabetes Mellitus, Type 2 (blood, drug therapy)
• Dipeptidyl-Peptidase IV Inhibitors (pharmacology, therapeutic use)
• Double-Blind Method
• Female
• Humans
• Hypoglycemic Agents (pharmacology, therapeutic use)
• Insulin (blood)
• Lipids (blood)
• Male
• Middle Aged
• Pioglitazone
• Piperidines (pharmacology, therapeutic use)
• Postprandial Period (drug effects)
• Thiazolidinediones (pharmacology, therapeutic use)
• Treatment Outcome
• Uracil (analogs & derivatives, pharmacology, therapeutic use)