Islet function and insulin sensitivity in latent autoimmune diabetes in adults taking sitagliptin: A randomized trial.

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The long-term effects of dipeptidyl peptidase-4 inhibitors on β-cell function and insulin sensitivity in latent autoimmune diabetes in adults (LADA) are unclear.To investigate the effects of sitagliptin on β-cell function and insulin sensitivity in LADA patients receiving insulin.A randomized controlled trial at the Second Xiangya Hospital.Fifty-one patients with LADA were randomized to sitagliptin + insulin group (SITA group) or insulin alone group (CONT group) for 24 months.Fasting C-peptide (FCP), 2-hour postprandial C-peptide (2hCP) during mixed-meal tolerance test, △CP (2hCP - FCP) and updated homeostatic model assessment of β-cell function (HOMA2-B) were deterrmined every 6 months. In 12 subjects, hyperglycemic clamp and hyperinsulinemic euglycemic clamp (HEC) tests were further conducted at 12-month intervals.During the 24-month follow-up, there were no significant changes in β-cell function in SITA group, whereas the levels of 2hCP and △CP in CONT group were reduced at 24 months. Meanwhile, the changes in HOMA2-B from baseline were larger in SITA group than in CONT group. At 24 months, first-phase insulin secretion was improved in SITA group by hyperglycemia clamp, which was higher than in CONT group (P<0.001), while glucose metabolized(M), insulin sensitivity index and M over logarithmical insulin ratio in HEC were increased in SITA group (all P<0.01 vs. baseline), which were higher than in CONT group.Compared with insulin intervention alone, sitagliptin plus insulin treatment appeared to maintain β-cell function and improve insulin sensitivity in LADA to some extent.

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