Ceyhun VARIM, Mehmet Şevki̇ UYANIK, Emine Ülkü AKÇAY, Tezcan KAYA, Perihan VARIM, Mehmet Bülent VATAN, Selçuk YAYLACI, Ahmet NALBANT, Feyzi GÖKOSMANOĞLU, Ali TAMER

Yeni Tanı Tip 2 Diabetes Mellitus’ lu hastalarda DPP-4 inhibitörlerinin HbA1c, Hematolojik ve İnflamasyon Parametreleri Üzerine Etkileri

Amaç: Sitagliptin ve vildagliptin ülkemizde son zamanlarda piyasaya sürülmüş Dipeptidil Peptidaz- 4 DPP-4 inhibitörü oral antidiyabetik ajanlardır. Amerikan Diyabet Cemiyeti ADA 2014 diabetes mellitus DM tedavi kılavuzuna göre metformin tedavisi ile kontrol altına alınamayan Tip 2 DM hastalarında 2.sıra tedavi olarak DPP-4 inhibitörleri tercih edilebilir. Biz bu çalışmamızda metformin tedavisi ile yeterli glisemik kontrol sağlayamadığımız ve tedaviye sitagliptin veya vildagliptin eklediğimiz hastalarda bu 2 ilacın inflamasyon ve kardiyovasküler riski azaltmada daha etkili olduğunu hemogram parametreleri üzerinden ortaya koymaya çalıştık. Yöntem ve Gereçler: Kliniğimiz Diyabet Polikliniğinde takipli Tip 2 DM tanısı ile günde 2 doz 1000 mg. toplam 2000 mg. metformin tedavisi alan ve metformin tedavisi ile yeterli kan şekeri regülasyonu sağlanamayıp tedaviye günde tek doz 100 mg sitagliptin veya günde 2 doz 50 mg. toplam 100 mg. vildagliptin eklenen hastaların dosyaları tarandı. Çalışmamızın dahil edilme ve dışlanma kriterlerine uyan 62 hasta tespit edildi. Hastalar metformin + sitagliptin kullanan grup Grup1 ve metformin + vildagliptin kullanan grup Grup2 olarak ikiye ayrıldı. Bu 2 grubun metformin tedavisine sitagliptin veya vildagliptin eklendiği andaki ve 6. ay sonundaki HbA1c, Vücut Kitle İndeksi VKİ ,beyaz küre sayımı WBC , Nötrofil Lenfosit Oranı NLR , Trombosit Lenfosit Oranı PLR , Ortalama Trombosit Hacimi MPV karşılaştırıldı Sitagliptin ve vildagliptin tedavilerinin bu parametreler üzerine etkileri ve biribirine üstünlükleri olup olmadığı araştırıldı. Bulgular: Metformin tedavisine sitagliptin eklenen Grup 1 ile metformin tedavisine vildagliptin eklenen Grup 2 demografik veriler açısından karşılaştırıldığında birbirine benzerdi Tablo-1 . Her 2 grupta 6 aylık tedavi sonunda benzer ve istatistiksel olarak anlamlı HbA1c grup1 p

Anahtar Kelimeler:

Sitagliptin, Vildagliptin, İnflamasyon, Kardiyovasküler risk

Effects of DPP-4 inhibitors on HbA1c, haematological parameters , parameters of inflammation in the patients with newly diagnosed Type 2 DM

Aim:Diabetes mellitus is a chronic inflammatory disease characterized by high blood sugar levels. The aim of the present study was to investigate the efficacy of vildagliptin and sitagliptin as an add-on to metformin in suppressing inflammation.Material and Methods: A total of 62 patients with Type 2 Diabetes Mellitus using metformin were included the study. The patients were classified into the two groups. Group 1 sitagliptin add-on to metformin treatment. Group 2 vildagliptin add-on to metformin treatment. Inflammatuar parameters such as, mean platelet volume MPV , platelet to lymphocyte ratio PLR , neutrophil to lymphocyte ratio NLR at the start of vildagliptin and sitagliptin treatment and in the 6th month of treatment were compared.Results: There were no significant differences in sex and age between two groups Table 1 . Similar and statistically significant reduction of HbA1c group1 p

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Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu 2015 s:24
International Diabetes Federation: Clinical guidelines task force, global guideline for type 2 diabetes. Brussels, Belgium: International Diabetes Federation; http://www.idf.org/webdata/ docs/IDF%20GGT2D.pdf; 2005 [accessed 7.07.10].
Inzucchi SE, McGuire DK: New drugs for the treatment of diabetes: part II: incretin-based therapy and beyond. Circulation 2008, 117:574–584.
McIntosh C., Demuth H., Pospisilik J., Pederson R., 2005. Dipeptidyl peptidase IV inhibitors: how do they work as new antidiabetic agents?, Regulatory Peptides, 128:159-65.
Imtiaz F, Shafique K, Mirza SS, et al. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 2012; 5: 2.
Kaya H, Ertaş F, İslamoğlu Y, Kaya Z, Atılgan ZA, Çil H, et al. Association between neutrophil to lymphocyte ratio and severity of coronary artery disease. Clin Appl Thromb Hemost 2014; 20: 50-4
Bhat T, Teli S, Rijal J, Bhat H, Raza M et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther. 2013 Jan;11(1):55-9.
Shen XH, Chen Q, Shi Y, Li HW. Association of neutrophil/ lymphocyte ratio with long-term mortality after ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Chin Med J 2010; 123: 3438-43.
Sünbül M, Gerin F, Durmuş E, Kıvrak T, Sarı I, Tigen K, et al. Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension. Clin Exp Hypertens 2014; 36: 217-21.
Azab B, Shah N, Akerman M, McGinn JT Jr. Value of platelet/ lymphocyte ratio as a predictor of all-cause mortality after non- STelevation myocardial infarction. J Thromb Thrombolysis 2012; 34:326-34
Gary T, Pichler M, Belaj K, Hafner F, Gerger A, Froehlich H, et al. Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One 2013; 8: e67688
Park Y, Schoene N and Harris W. Mean platelet volume as an indicator of platelet activation: Methodological issues. Platelets 2002; 13: 301-306
Vinik AI, Erbas T, Park TS, Nolan R and Pittenger GL. Platelet dysfunction in type 2 diabetes. Diabetes Care 2001; 24: 1476-1485.
Vizioli L, Muscari S and Muscari A. The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases. Int J Clin Pract 2009; 63: 1509-1515.
de Rooij SR, Nijpels G, Nilsson PM, et al. Low-grade chronic inflammation in the relationship between insulin sensitivity and cardiovascular disease (RISC) population: associations with insulin resistance and cardiometabolic risk profile. Diabetes Care 2009; 32: 1295–1301
Fernandez-Real JM and Ricart W. Insulin resistance and chronic cardiovascular inflammatory syndrome. Endocr Rev 2003; 24: 278–301
Andersson C, van Gaal L, Caterson ID, et al. Relationship between HbA1c levels and risk of cardiovascular adverse outcomes and allcause mortality in overweight and obese cardiovascular high- risk women and men with type 2 diabetes. Diabetologia 2012; 55:2348–2355
Bo Ahren, Novel combination treatment of type 2 diabetes DPP-4 inhibition + metformin Vasc Health Risk Manag. 2008 Apr; 4(2): 383–394.
A. D. Dobrian, Q Ma, J. W. Lindsay, K. A. Leone, K. Ma, J. Coben, E. V. Galkina, J. L. Nadler. Dipeptidyl peptidase IV inhibitor sitagliptin reduces local inflammation in adipose tissue and in pancreatic islets of obese mice Am J Physiol Endocrinol Metab. 2011 Feb; 300(2): E410–E421.
Mathieu C., Degrande E., Vildagliptin: a new oral treatment for type 2 diabetes mellitus. Vasc Health Risk Manag. 2008 Dec; 4(6): 1349–1360.
Meiqin L., Peng L., Ru T., Yixian P., Siyuan Y., Wanjing H., Lei H. Relationship between neutrophil-lymphocyte ratio and insulin resistance in newly diagnosed type 2 diabetes mellitus patients. BMC Endocrine Disorders (2015) 15:9 DOI 10.1186/s12902-015-0002-9
Yilmaz H., Ucan B., Sayki M., Unsal I., Sahin M,, Ozbek M., Delibasi T., Usefulness of the neutrophil-to-lymphocyte ratio to prediction of type 2 diabetes mellitus in morbid obesity. Diabetes & Metabolic Syndrome: Clinical Research & Reviews (2014)
Sefil F., Ulutas KT., Dokuyucu R., Sumbul AT., Yengil E.,Yagiz EA., Yula E., Ustun I., Gokce C.; Investigation of neutrophil lymphocyte ratio and blood glucose regulation in patients with type 2 diabetes mellitus. Journal of International Medical Research 2014, Vol. 42(2) 581–588
Lee GK, Lee LC, Chong E, Lee CH, Teo SG, Chia BL, et al. The long-term predictive value of the neutrophil-to-lymphocyte ratio in Type 2 diabetic patients presenting with acute myocardial infarction. QJM. 2012;105:1075–82.
Oylumlu M., Yıldız A., Yüksel M., Korkmaz A., Aydın M., Bilik M.Z., Akıl M.A., Ülgen S. Usefulness of Platelet-Lymphocyte Ratio to Predict Stent Thrombosis in Patients with ST Elevation Myocardial Infarction Koşuyolu Heart Journal 2014;17(2):81-85 • DOI: 10.4274/khj.88597
Hudzik B, Szkodzinski J, Gorol J, Niedziela J, Lekston A, Gasior M, Polonski L., Platelet-to-lymphocyte ratio is a marker of poor prognosis in patients with diabetes mellitus and ST-elevation myocardial infarction. Biomark Med. 2015;9(3):199-207. doi: 10.2217/bmm.14.100.
Papanas N, Symeonidis G, Maltezos E, et al. Mean platelet volüme in patients with type 2 diabetes mellitus. Platelets. 2004; 15(8):475-478.
Akyuz A., Dursun C¸ Akkoyun A.,Degirmenci H., Oran M., Rosuvastatin Decreases Mean Platelet Volume in Patients With Diabetes Mellitus Angiology 2015; (1) 1-5