Predictive Factors for Efficacy of Dipeptidyl Peptidase-4 Inhibitors in Patients with Type 2 Diabetes Mellitus

BACKGROUND: Predictive factors for the efficacy of dipeptidyl peptidase-4 (DPP-4) inhibitors for lowering glycosylated hemoglobin (HbA1c) remain unclear in patients with type 2 diabetes mellitus. The aim of this study is therefore to clarify predictive factors of the efficacy of DPP-4 inhibitors for lowering HbA1c after 12 months of treatment. METHODS: A total of 191 consecutive type 2 diabetic patients (male sex 55%, mean age, 68.3+/-35.8 years), who had been treated with DPP-4 inhibitors for 12 months, were enrolled in this study and evaluated retrospectively. RESULTS: After 12 months of DPP-4 inhibitor treatment, random blood glucose level, and HbA1c level, decreased from 167+/-63 to 151+/-49 mg/dL (P<0.01), and from 7.5%+/-1.3% to 6.9%+/-0.9% (P<0.01) respectively, without severe side effects. Multiple regression analysis showed that predictors of DPP-4 inhibitor treatment efficacy in lowering HbA1c level after 12 months were a decrease in HbA1c level after 3 months of treatment, a high baseline HbA1c level, a low baseline body mass index, and the absence of coronary artery disease. CONCLUSION: Most suitable candidates for treatment with DPP-4 inhibitors are diabetics who are not obese and do not have coronary artery disease. In addition, long-term efficacy of DPP-4 inhibitors can be predicted by decrement of HbA1c after 3 months of treatment.

Therapeutic potential of ghrelin in cardiac diseases.

It has recently been revealed that ghrelin, a hormone discovered in the stomach, has a potential therapeutic role in the treatment of diseased hearts. In human patients with heart failure and in animal models, repeated subcutaneous administration of ghrelin improves cardiac dysfunction and remodeling. Moreover, ghrelin treatment early after myocardial infarction effectively reduces fatal arrhythmia and, consequently, mortality. The beneficial effects of ghrelin result from a growth hormone increase, an orexigenic effect, direct actions to the cardiovascular cells and its potent inhibitory action on sympathetic nervous activity, which is excessively activated in cardiac diseases. These results suggest that ghrelin could be a promising novel therapeutic agent for cardiac diseases.