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Aims/Introduction  The goal of the study was to examine the effects of sitagliptin dose‐up or glimepiride dose‐up in  J apanese patients with type 2 diabetes who were controlled inadequately by sitagliptin and glimepiride in combination.    Materials and Methods  A multicenter, prospective, randomized, open‐label study was carried out in 50 patients with type 2 diabetes treated with sitagliptin and low‐dose glimepiride. The patients were randomly assigned to receive the addition of 50 mg/day sitagliptin or 0.5 mg/day glimepiride. The primary end‐point was the percentage change in glycated hemoglobin ( H b A 1c).    Results  During a follow‐up period, the difference in the percentage changes in  H b A 1c between the two groups was not significant ( P  = 0.13). However,  H b A 1c was significantly decreased by glimepiride dose‐up ( P  < 0.01 vs baseline), but not by sitagliptin dose‐up ( P  = 0.74). Univariate linear regression analyses showed that the percentage change in  H b A 1c was significantly associated with the serum level of arachidonic acid ( AA ) in both groups.    Conclusions  There was no significant difference in the  H b A 1c‐lowering effects between the two groups. However, a significant  H b A 1c‐lowering effect from baseline of glimepiride dose‐up was found, and the  AA  level showed a negative correlation with the decrease in  H b A 1c in the sitagliptin dose‐up group, but a positive correlation in the glimepiride dose‐up group. These findings suggest that the  AA  level is associated with  H b A 1c reduction in response to dose‐up with these drugs in patients with type 2 diabetes in a combination therapy with sitagliptin and glimepiride. This trial was registered with  UMIN  (no. 9544).

journal of diabetes investigation

Comparison of the efficacy of sitagliptin and glimepiride dose‐up in  J apanese patients with type 2 diabetes poorly controlled by sitagliptin and glimepiride in combination