Factors associated with the glucose‐lowering efficacy of sitagliptin in Japanese patients with type?2 diabetes mellitus: Pooled analysis of Japanese clinical trials

摘要

Aims/Introduction To explore the factors associated with the glucose‐lowering efficacy of sitagliptin treatment in Japanese patients with type?2 diabetes mellitus. Materials and Methods This was a post‐hoc analysis of pooled data from seven sitagliptin phase?II and III clinical studies carried out in Japan. All studies were double‐blind, randomized, placebo‐controlled, parallel‐group and of 12‐week duration. The analysis population consisted of 1,075 type?2 diabetes mellitus patients. In two of the trials, sitagliptin 50?mg and/or 100?mg daily were used as monotherapy; in five others, sitagliptin 50?mg daily was used as add‐on treatment to ongoing pioglitazone, glimepiride, metformin, voglibose or glinides. Efficacy (reduction in hemoglobin A1c [HbA1c]) was evaluated in 12 sets of subgroups defined by demographic, glycemic, pancreatic β‐cell function and insulin resistance parameters. An analysis of covariance model was used to evaluate the interaction between each parameter and efficacy. Results Sitagliptin consistently provided a clinically meaningful reduction in HbA1c relative to placebo across all subgroups. Within subgroups, a greater absolute HbA1c reduction was associated with higher baseline HbA1c, fasting plasma glucose and 2‐h post‐meal glucose. Lower β‐cell function, represented by homeostatic model assessment of β‐cell function and insulinogenic index, was also associated with greater HbA1c reduction. In contrast, age, sex, body mass index, duration of type?2 diabetes mellitus and insulin resistance‐related parameters did not interact with HbA1c changes. Conclusions Sitagliptin treatment was associated with clinically meaningful improvement in glycemic control in all subgroups of Japanese patients with type?2 diabetes mellitus that were evaluated. Higher baseline glycemic status and lower baseline β‐cell function were identified as factors associated with greater HbA1c reduction after sitagliptin treatment.