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The addition of the dipeptidyl peptidase 4 (DPP-4) inhibitor vildagliptin to metformin therapy in fasting Muslim patients with Type 2 diabetes reduces the incidence of hypoglycemia compared with the addition of the sulfonylurea gliclazide, research suggests.

“If a person with diabetes chooses to fast during Ramadan, his or her decision needs to be respected and an appropriate care plan needs to be devised,” explain the study authors Devasenan Devendra (Central Middlesex Hospital, London, UK) and co-workers.

To study the impact of Ramadan fasting by Muslims with Type 2 diabetes in the UK, the authors followed 52 patients attending primary care practices in north-west London for an average of 7.5 weeks.

Participants had glycated hemoglobin (HbA1c) greater than 8.5% despite treatment with metformin 2 g daily before Ramadan, and were receiving gliclazide 160 mg twice daily or vildagliptin 50 mg twice daily in addition to metformin.

Hypoglycemic events (defined as blood glucose of less than 3.5 mmol/l with or without symptoms), HbA1c, and weight were recorded 2 weeks before and 10 days after the Ramadan fast.

Patients receiving gliclazide experienced a total of 24 hypoglycemic events, one of which was severe, while those receiving vildagliptin experience a total of two hypoglycemic events, neither of which were severe. Among patients receiving the sulfonylurea, 62% suffered a hypoglycemic event, compared with 8% of those taking vildagliptin.

“Vildagliptin was associated with a reduction in the mean number of hypoglycemic events during Ramadan compared with before Ramadan (when patients were on metformin monotherapy), whereas gliclazide was associated with an increase,” write the authors.

Gliclazide and vildagliptin were associated with similar reductions in HbA1c of 1.23% and 1.26%, respectively. Both agents were associated with a small non-significant increase in weight of 0.38 kg and 0.12 kg, respectively.

The authors acknowledge that this was an observational study of a relatively small number of patients with Type 2 diabetes and highlight the need for larger, prospective studies of the different interventions that may help Muslim patients fast safely during Ramadan.

“Newer antidiabetic agents, such as vildagliptin, may have a role to play in the management of these patients during Ramadan, particularly to reduce their risk of hypoglycemia during the long daytime fasting periods,” they conclude in the International Journal of Clinical Practice.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Build-up of fat in the pancreas increases with increasing body mass index (BMI) and is associated with elevated risk for Type 2 diabetes, show results from a magnetic resonance spectroscopy (MRS) study.

“These are very early results, but if they hold true, pancreatic MRS would be a fast and noninvasive test to screen people at risk for diabetes either because they’re obese or they have a family history of Type 2 diabetes, or the metabolic syndrome,” said lead author Ildiko Lingvay (University of Texas Southwestern Medical Center, Dallas, Texas).

“It could potentially tell physicians which patients are most likely to develop diabetes in the near future and thus are in need of more aggressive interventions,” she added.

The researchers first validated the MRS method by measuring the pancreatic triglyceride content of 12 lean and 12 fatty rats. They then used MRS to measure the pancreatic fat or triglyceride content of 79 human volunteers. Of these, 33 had duplicate measurements taken 1??”2 weeks apart.

Writing in the Journal of Clinical Endocrinology and Metabolism, the team reports that participants who were of normal weight and normoglycemic had a median pancreatic triglyceride content of 0.46 f/w%. In those who were overweight or obese (BMI above 25 kg/m²) but normoglycemic this increased to a median of 3.16 f/w%.

Overweight or obese individuals who also had impaired fasting glucose or glucose tolerance had an even higher pancreatic triglyceride content of 5.64 f/w%, which was very similar to the value for participants with untreated Type 2 diabetes (5.54 f/w%).

“The method offers a unique strategy for early detection of ectopic fat accumulation in high-risk individuals,” conclude Lingvay and team.

“Our results set the stage for future studies to determine if pancreatic steatosis leads to B-cell dysfunction and if interventions that reduce plasma triglycerides levels favorably impact B-cell function,” they add.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract