Saxagliptin is noninferior to sitagliptin for the treatment of Type 2 diabetes when added to metformin therapy, show study results.

Andre Scheen (University of Liège, Belgium) and colleagues report the results of a phase IIIb study comparing saxagliptin 5 mg/day with sitagliptin 100 mg/day in addition to metformin 1500-3000 mg/day for the treatment of Type 2 diabetes.

The researchers enrolled 801 patients to the study, aged 58.4 years on average, with a glycated hemoglobin (HbA1c) level between 6.5% and 10.0%. Of these, 403 were randomly assigned to take saxagliptin and metformin and 398 to take sitagliptin and metformin for a period of 18 weeks.

Efficacy was measured by change in HbA1c from baseline at the end of the study. HbA1c was reduced at 18 weeks by 0.52% and 0.62% in the saxagliptin and sitagliptin groups, respectively. This amounted to a between-group difference of 0.09%, which was nonsignificant.

Overall, 97 patients (33.0%) in the saxagliptin plus metformin group and 117 patients (39.1%) in the sitagliptin plus metformin group achieved a HbA1c of less than 7.0% at week 18.

Both saxagliptin and sitagliptin were generally well tolerated, with an incidence of any treatment-related adverse event of 5.2% and 7.5%, respectively. The most common types of adverse events experienced by patients were influenza, urinary tract infection, nasopharyngitis, headache, and diarrhea. Hypoglycemia, which was mostly mild, occurred in around 3% of both groups.

Body weight decreased slightly in both groups by approximately 0.4 kg. “The absence of weight gain despite a significant improvement in glycemic control represents an advantage of dipeptidyl peptidase-4 inhibitors compared with other oral glucose-lowering agents such as sulphonylureas, or thiazolidinediones such as pioglitazone,” write the authors.

The results of this study are published in the journal Diabetes/Metabolism Research and Reviews.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Results from the Black Women’s Health Study suggest that consumption of moderate amounts of caffeinated coffee and alcohol may reduce the risk for developing Type 2 diabetes.

However, tea and decaffeinated coffee consumption did not significantly influence diabetes risk.

Julie Palmer (Boston University, Massachusetts, USA) and colleagues assessed the coffee, tea, and alcohol intake of 46,906 African-American women using validated food-frequency questionnaires at baseline in 1995.

The women were followed-up for a mean period of 12 years for incident Type 2 diabetes, during which time 3671 cases were identified.

As reported in the American Journal of Clinical Nutrition, increased intake of caffeinated coffee and alcohol, but not decaffeinated coffee or tea, was associated with reduced Type 2 diabetes risk.

The women were divided into caffeinated coffee consumption categories of 0-1, 1, 2-3, and 4 cups/day or more and alcohol consumption categories of 1-3, 4-6, 7-13, and 14 alcoholic drinks/week or more.

The team found that relative to no caffeinated coffee consumption, those in the lowest to the highest categories of consumption had a significant trend for decreasing relative risk for Type 2 diabetes (6-17% reductions from lowest to highest group).

Similarly, there was also a significant trend for reduction in relative risk for Type 2 diabetes associated with increasing alcohol intake (reductions of 10-32%).

The results of this research agree with those of previous studies suggesting that high coffee intake may reduce the risk for Type 2 diabetes, as reported by MedWire News, although other studies have found that tea consumption is also associated with reduced risk.

The authors propose several mechanisms to explain the beneficial effects of coffee and alcohol on risk for diabetes. They say coffee is a rich source of antioxidants such as chlorogenic acid and lignans, and has beneficial effects on inflammation and serum lipids. Regarding alcohol, they add that there is some evidence to suggest that moderate consumption may help improve insulin sensitivity.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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High coffee consumption lowers risk for Type 2 diabetes
Coffee and tea drinking may reduce risk for Type 2 diabetes
Coffee and tea consumption reduces the risk for Type 2 diabetes

A low serum concentration of fetuin-A is a significant independent predictor of reduced ankle-brachial index (ABI) in patients with Type 2 diabetes, show study results.

Fetuin-A is a an inhibitor of vascular calcification and a mediator of insulin resistance, low levels of which have previously been associated with cardiovascular disease, as reported by MedWire News.

In this study, Marcel Roos (Klinikum rechts der Isar, Munich, Germany) and colleagues recruited 153 patients with Type 2 diabetes and early diabetic nephropathy to assess links between fetuin-A and inflammatory, metabolic, and vascular markers. Atherosclerotic burden was also evaluated using the ABI and by measurement of carotid intima-media thickness (IMT).

Fetuin-A levels were a mean of 0.51 g/l, and ranged from 0.30 to 1.07 g/l. Age was significantly and inversely associated with fetuin-A levels. Concentrations were also significantly lower in men than women, at 0.49 vs 0.56 g/l.

Adiponectin, but no other metabolic variable, was inversely and significantly associated with fetuin-A.

No links with carotid IMT were observed, but patients with an ABI below 0.9 had significantly lower fetuin-A levels than those with an ABI of 0.9-1.3 or higher, at 0.43 versus 0.52 and 0.54 g/l, respectively.

The researchers also found that there was a trend for lower levels of fetuin-A in patients with a prior history of macrovascular disease.

When fetuin-A levels were measured in 69 diabetic patients with prevalent polyneuropathy (PNP) and 84 diabetic controls without PNP, concentrations were not significantly different between the two groups, at 0.50 and 0.52 µg/ml, respectively.

Further analysis showed that only fetuin-A and total cholesterol concentration were significant independent predictors of having an ABI below 0.9.

“This study demonstrates that lower fetuin-A levels seem to be associated with prevalent macrovascular disease in Type 2 diabetes, but not with carotid IMT as a surrogate marker of atherosclerotic burden,” write the authors in the journal Cardiovascular Diabetology.

“Furthermore, we could show for the first time, that fetuin-A serum levels are not associated with microvascular complications in patients with early diabetic nephropathy,” they conclude.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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