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BackgroundDipeptidyl peptidase-4 inhibitors (DPP-4i) have become widely used in hemodialysis patients with type 2 diabetes mellitus (T2DM). This study aimed at testing the hypothesis that administration of alogliptin, a DPP-4i, soon after hemodialysis initiation improves beta cell function in hemodialysis patients with T2DM.MethodsPatients with end-stage renal disease and T2DM (n = 10) not previously treated with DPP-4i (mean age, 54.2 years) were enrolled.The study end point was the acute insulin response to glucose assessed by a frequently sampled intravenous glucose tolerance test (IVGTT) that was conducted during the hemodialysis session just before lunch using an external circulation circuit. All patients received 6.25 mg alogliptin for 2 weeks.Blood glucose (Glu), serum insulin (IRI), and C-peptide (CPR) were measured before (0 min) in addition to 5 and 15 min after the glucose load. Glucagon-like peptide-1 (GLP-1) was measured before the glucose load.ResultsGlu(0) significantly decreased after the 2-week DPP-4i treatment (174 ± 20 vs. 150 ± 27 mg/dL, P = 0.023). IRI(5) significantly increased after the DPP-4i treatment (14.6 ± 31.7 vs. 23.4 ± 16.6 μU/mL, P = 0.038), but IRI(0) and IRI(15) did not change significantly. GLP-1 also significantly increased after the DPP-4i treatment (6.6 ± 4.4 vs. 2.6 ± 0.8 pmol/L, P = 0.012).ConclusionsInhibition of DPP-4 with alogliptin improved endogenous insulin secretion in response to intravenous glucose in hemodialysis patients with T2DM.

renal replacement therapy

The dipeptidyl peptidase-4 inhibitor may improve the insulin secretion in type 2 diabetes patients just after starting hemodialysis treatment: preliminary study