DPP4 抑制剂疗法在囊性纤维化相关糖尿病中的作用：单一中心的经验。

IF 5.4 2区医学 Q1 RESPIRATORY SYSTEM Journal of Cystic Fibrosis Pub Date : 2024-09-01 DOI:10.1016/j.jcf.2024.06.007

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引用次数: 0

摘要

简介：虽然二肽基肽酶-4 抑制剂（DPP4-I）等口服生物增量素模拟药物在 2 型糖尿病中的作用已得到确认，但有关其在囊性纤维化相关糖尿病（CFRD）中的作用的数据却很少：方法：从我们的囊性纤维化病专科门诊中找出开具 DPP4-I 治疗处方的囊性纤维化病患者，并对其治疗指征、耐受性和有效性的记录进行回顾性检查。对这些患者治疗前和治疗后至少 3 个月的连续血糖监测数据 Libre 2 进行了分析。结果：23 名平均（标清）年龄为 35.0 ± 2.4 岁的 CF 患者（PwCF）被纳入本次分析。21 名患者接受了 DPP4-I 单药治疗，另有 2 名患者接受了 DPP4-I 与胰岛素联合治疗。治疗指征包括反应性低血糖（10 例）、餐后高血糖（8 例）、避免使用胰岛素（3 例）、二甲双胍不耐受（1 例）和不明确（1 例）。治疗耐受性良好，没有因不良反应而停药。治疗前与治疗后的在量程时间对比有明显改善：78.0 [67.5 - 84.0] vs 89.0 [79.8 - 96.0]%，p = 0.005；超过量程的时间 - 治疗前 vs 治疗后：19.5 [12.5 - 30.8] vs 6.0 [2.5 - 16.5]%，p = 0.006；血糖变异性 - 前 vs 后：28.3 [25.4 - 31.1] vs 26.9 [23.1 - 31.3]，p = 0.021，在 10 名开始接受低血糖治疗的受试者中，有 7 人报告症状有所改善。治疗前后体重无明显差异：61.5±15.0千克 vs 62.5±15.3 千克，p = 0.326 或 Hba1c 前后无明显差异：41.0 [36.0 - 53.3] mmol/mol 对 40.5 [36.8 - 47.3]，p = 0.727：DPP4-I在CFRD患者中耐受性良好，可改善这些患者的血糖控制，并显著改善有效的CGM指标。

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Role for DPP4 inhibitor therapy in cystic fibrosis related diabetes: A single centre experience

Introduction

Insulin remains the only recommended medical treatment for cystic fibrosis related diabetes (CFRD) Whilst there is an established role for orally bioavailable incretin mimetic agents such as the dipeptidyl peptidase-4 inhibitors (DPP4-I) in Type 2 diabetes mellitus, there exists little data on their utility in CFRD.

Aim

To examine the use of DPP4-I therapy in patients with CFRD at a single large adult cystic fibrosis center.

Method

People with CFRD prescribed a DPP4-I were identified from our specialist CFRD clinic and records were retrospectively examined for indication for therapy, tolerability and effectiveness. Analysis of continuous glucose monitoring data Libre 2 was done for these patients (CGM) pre and at least 3 months post therapy was performed.

Results

23 people with CF (PwCF) with a mean (SD) age of 35.0 ± 2.4 years were included in this analysis . In 21 patients DPP4-I was prescribed as a monotherapy and it was given in combination with insulin in 2 others. Indications for therapy included reactive hypoglycaemia (n = 10) post prandial hyperglycaemia (8), insulin avoidance (3), metformin intolerance (1) and unclear (1). Therapy was well tolerated with no discontinuations due to adverse effects. Significant improvements were noted in Time in Range- Pre vs Post: 78.0 [67.5 – 84.0] vs 89.0 [79.8 – 96.0]%, p = 0.005, Time above Range -Pre vs Post: 19.5 [12.5 – 30.8] vs 6.0 [2.5 – 16.5]%, p = 0.006 and glucose variability Pre versus Post: 28.3 [25.4 – 31.1] vs 26.9 [23.1 – 31.3], p = 0.021, Of the 10 subjects who initiated therapy for hypoglycaemia, 7 reported an improvement in symptoms. No significant difference was found in weight pre and post: 61.5 ± 15.0 kg vs 62.5 ± 15.3 kg, p = 0.326 or Hba1c pre vs post: 41.0 [36.0 – 53.3] mmol/mol versus 40.5 [36.8 – 47.3], p = 0.727.

Conclusion

DPP4-I is well tolerated in CFRD and can lead to an improved glycaemic control in these patients with significant improvement in validated CGM metrics

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来源期刊

Journal of Cystic Fibrosis 医学-呼吸系统

CiteScore

10.10

自引率

13.50%

发文量

1361

审稿时长

50 days

期刊介绍： The Journal of Cystic Fibrosis is the official journal of the European Cystic Fibrosis Society. The journal is devoted to promoting the research and treatment of cystic fibrosis. To this end the journal publishes original scientific articles, editorials, case reports, short communications and other information relevant to cystic fibrosis. The journal also publishes news and articles concerning the activities and policies of the ECFS as well as those of other societies related the ECFS.