Sitagliptin reduces the urine albumin‐to‐creatinine ratio in type 2 diabetes through decreasing both blood pressure and estimated glomerular filtration rate 西格列汀通过降低2型糖尿病患者的血压以及估算的肾小球滤过率来减少尿白蛋白/肌酐的比值

Background We investigated the change in the urine albumin‐to‐creatinine ratio ( ACR ) to examine the effect of sitagliptin on diabetic nephropathy. Methods Sitagliptin at a dose of 50 mg was administered to 247 outpatients with type 2 diabetes. Data were collected on the patients' laboratory results (including the ACR ), blood pressure, and body weight. Clinical data were compared before and after 3 months' administration of sitagliptin. Results The ACR changed from 150.0 ± 538.6 mg/gCre to 148.3 ± 764.6 mg/gCre over 3 months. In the patients with micro‐ and macro‐albuminuria, the ACR after 3 months significantly decreased compared with the baseline ( P  = 0.04 and P  = 0.02, respectively). The subjects whose ACR decreased experienced significantly larger decreases over the 3‐month period in blood pressure and estimated glomerular filtration rate ( eGFR ) than the other subjects. There was no significant correlation between change in ACR ( ΔACR ) and change in hemoglobin A1c ( ΔHbA1c ) during 3 months ( r  = 0.04, P  = 0.59), but there was a significant correlation between change in ΔACR and change in systolic blood pressure ( r  = 0.16, P  = 0.03). Multiple regression analysis revealed that the significant predictors for ΔACR were change in systolic blood pressure (β = 0.21, P  = 0.016) and change in eGFR (β = 0.20, P  = 0.024) over 3 months ( r  = 0.35, P  = 0.04). Conclusions Sitagliptin reduces the ACR through decreasing both blood pressure and eGFR , with no correlation with a decrease in HbA1c over a 3‐month period. These results may reflect the direct action of sitagliptin on the kidneys.