Diabetes, Metabolic Syndrome and Obesity (Oct 2020)

Add-On Therapy with DPP-4 Inhibitors May Improve Renal Function Decline in α-Glucosidase Inhibitor and Metformin Users: A Retrospective Observational Study

  • Osonoi T,
  • Saito M,
  • Koda N,
  • Douguchi S,
  • Nakano T,
  • Ofuchi K,
  • Katoh M

Journal volume & issue
Vol. Volume 13
pp. 3497 – 3506

Abstract

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Takeshi Osonoi, Miyoko Saito, Naoya Koda, Satako Douguchi, Takako Nakano, Kensuke Ofuchi, Makoto Katoh Naka Kinen Clinic, Ibaraki, JapanCorrespondence: Makoto KatohNaka Kinen Clinic, 745-5 Nakadai, Naka-Shi, Ibaraki 311-0113, JapanTel +81-29-353-2800Fax +81-29-295-5400Email [email protected]: We retrospectively evaluated the long-term effect of dipeptidyl peptidase (DPP)-4 inhibitors on estimated glomerular filtration rate (eGFR) slopes, and then evaluated the beneficial interaction between DPP-4 inhibitor initiation and baseline use of α-glucosidase inhibitor and/or metformin in patients with diabetic kidney disease.Patients and Methods: Altogether, 1512 patients with type 2 diabetes were receiving DPP-4 inhibitor therapy over 1 year and were followed up for a maximum of 2 years before and after 7 years of treatment. The decline in renal function was estimated as the slope of the individual linear regression line of eGFR over 2-year follow-up. Prescription data on medications before and after DPP-4 inhibitor treatment were examined.Results: The mean length of DPP-4 inhibitor treatment was 5.3 ± 2.6 years. The baseline mean eGFR slope (mL/min/1.73m2/year) was − 2.24 ± 6.05. After DPP-4 inhibitor treatment, mean eGFR slope was significantly improved (− 1.53 ± 6.36, P < 0.01) in patients with type 2 diabetes. This effect appeared more pronounced for baseline use of α-glucosidase inhibitor and/or metformin in patients with diabetic kidney disease. These non-users showed a trend towards attenuation or no effects.Conclusion: In the present study, patients treated with DPP-4 inhibitors had a significantly slower annual loss of kidney function. The benefit appears pronounced in α-glucosidase inhibitor and metformin users with advanced renal dysfunction. These results suggest that the beneficial effects of DPP-4 inhibitors on kidney function may have occurred in the presence of an α-glucosidase inhibitor and/or metformin.Keywords: DPP-4 inhibitor, α-glucosidase inhibitor, metformin, eGFR slope, type 2 diabetes

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