Diabetes Mellitus
Conditions
Keywords
DPP-4; GLP1R ; gene polymorphism research; diabetes
Brief summary
Incretin-based therapy is currently one of the most popular diabetes treatment approaches. However, differences of response ware found in previous studies. We hypothesis that SNPs of DPP-4, GLP-1 and GLP-1R genes may play crucial roles in the response differences. Therefore, this study aims to investigate the correlation of incretin-related gene polymorphism and individual differences in the response of DPP-4 inhibators (take Sitagliptin as an example). In addition, The distribution differences of the SNPs in diabetics and non-diabetics are evaluated to study the relationships between the SNPs and diabetes onsets.
Detailed description
Single Nucleotide Polymorphism (SNP) plays an important role in the differences of clinical manifestations and drug responses of diseases. The vast majority of SNP sites are located in the non-coding region of the gene (about 95%), which is called SNP(non-coding SNP (ncSNP), while the other part of SNP is located in the coding region of the gene, which is called coding SNP (cSNP). Furthermore, cSNP can be divided into two categories: SNP that does not change the encoded amino acid sequence is called synonymous SNP(synonymous SNP, SSNP); SNP that changes amino acid sequence is called SNP(non-synonymous SNP (NSNP). Although not involved in coding amino acid, some ncSNPs may also affect the regulation of protein expression. Therefore, it is of great significance to study the effects of NC SNP and cSNP on the occurrence and development of diseases and drugs. DPP-4 enzyme inhibitor is combined with DPP-4 enzyme in human body to reduce hydrolysis of active GLP-1, thus increasing the level of endogenous active GLP-1. Active GLP-1 combines with its receptor GLP-1R to promote insulin release and inhibit glucagon release in hyperglycemia state, and produces opposite effect in hypoglycemia state. Based on the above principles, we speculate that SNP of genes that may affect the hypoglycemic effect of DPP-4 enzyme inhibitor are: 1. SNP of DPP-4 enzyme gene. SNP of DPP-4 enzyme gene may affect the enzyme activity and/or protein expression level of DPP-4. Assuming that the effect of DPP-4 enzyme inhibitor is sufficient, patients with higher DPP-4 enzyme activity are more sensitive to DPP-4 enzyme inhibitor drugs; However, for patients with low DPP-4 enzyme activity, DPP-4 enzyme inhibitor drugs cannot play a stronger role in lowering blood sugar. 2. SNP of GLP-1 gene. SNP of GLP-1 gene may affect activity or expression level of GLP-1. Patients with high GLP-1 level are more sensitive to DPP-4 enzyme inhibitor drugs. 3. SNP of GLP-1R gene. SNP of GLP-1R gene may affect activity or expression level of GLP-1R. Patients with high GLP-1R level are also more susceptible to DPP-4 enzyme inhibitor drugs. However, studies on the hypoglycemic effect of DPP-4, GLP-1 and their receptors on DPP-4 enzyme inhibitors in the treatment of T2DM are rare, which is not conducive to the evaluation of individualized treatment of such drugs. Therefore, this chapter intends to select SNP sites with high mutation frequencies of DPP-4, GLP-1 and GLP-1R genes to study the mutation frequencies of these SNPs in diabetic patients and non-diabetic patients and their effects on DPP-4 enzyme inhibitor sitagliptin's hypoglycemic effect on T2DM patients.
Interventions
DRUGSitagliptin
100mg.QD for 3 months
Sponsors
Sichuan Provincial People's Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
Yes
Inclusion criteria
For Sitagliptin group-- Inclusion Criteria: 1. According to diagnostic criteria from Chinese type 2 diabetes prevention and treatment guidelines in diabetes, that published in the Chinese Medical Association Diabetes credits in 2010: Symptoms of diabetes (polydipsia, polyphagia, polyuria, weight loss, itchy skin, blurred vision and other acute metabolic disorders performance caused by hyperglycemia) and RBG≥11.1mmol/L, or fasting plasma glucose (FPG)≥7.0mmol/L, or plasma glucose of 2 hours post glucose-load≥11.1 and patients diagnosed with type 2 diabetes; HbA1c in the range of 7%-10%; 2. Age 40-70 years; 3. Body Mass Index(BMI) 18-40; 4. Did not accepted any antihyperglycemic therapies during the past 4 weeks, or did not change their antihyperglycemic treatment plan in the past 3 months; 5. Did not participate in clinical trials within three months; 6. No serious heart, brain, liver and kidney disease; 7. Signed informed consent.
Exclusion criteria
1. Have taken any incretin drugs within recent 1 month; 2. Patients with a weakened immune system; 3. C-peptide \< 0.3ng/ml; 4. GLP-1 and DPP4-i drugs allergies; 5. Pregnancy and breast-feeding patients; 6. Patients taking drugs that may affect the metabolism of GLP-1 and DPP4; 7. Patients have serious heart, liver, kidney and respiratory dysfunction; Patients have medullary thyroid carcinoma (MTC) with past history or family history, as well as multiple endocrine neoplasia type 2 syndrome (MEN2); 8. Drug abusing and alcoholism within a year. For non-T2D group-- No major diseases such as tumors, no dyslipidemia, chronic diseases such as hypertension, and non-diabetic patients whose blood sugar and glycated hemoglobin values cannot meet the criteria for diagnosis of T2DM, and the age is over 50 years old.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Glycosylated Hemoglobin A1c (HbA1c) | 12 weeks later | non-T2D subjects only tested HbA1c at baseline. Of the 71 patients who completed the study, 69 collected HbA1c at both baseline and study endpoint, and 2 subjects did not carry out HbA1c measurement for personal reasons. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Types of Gene Polymorphism | Baseline | 24 SNPs genetic points of DPP-4, GLP-1 and GLP-1R. |
| Change in Blood Glucose | Basline and 12 weeks later. Fasting, 0.5h, 2h,3h after take 75g glucose orally. | Fasting Blood glucose, the postprandial 0.5-hour,2-hour,3-hour blood glucose were measured at baseline and at study end points, and the difference between baseline and study end points were compared.Participants in Non-T2DM Group were not taking Sitagliptin, so their blood glucose were not measured. |
| Change in Insulin | Basline and 12 weeks later. Fasting and 0.5h, 2h,3h after take 75g glucose orally. | Fasting insulin, the postprandial 0.5-hour,2-hour,3-hour insulin were measured at baseline and at study end points, and the difference between baseline and study end points were compared.The changes in fasting insulin, the postprandial 0.5-hour,2-hour,3-hour insulin were compared among patients with different genotypes at baseline and at study end points.Participants in Non-T2DM Group were not taking Sitagliptin, so their insulin were not measured. |
| Change in C-peptide | Basline and 12 weeks later. Fasting and 2h after take 75g glucose orally. | Fasting C-peptide, the postprandial 2-hour C-peptide were measured at baseline and at study end points, and the difference between baseline and study end points were compared.The changes in fasting C-peptide, the postprandial 2-hour C-peptide were compared among patients with different genotypes at baseline and at study end points.Participants in Non-T2DM Group were not taking Sitagliptin, so their C-peptide were not measured. |
Countries
China
Participant flow
Recruitment details
All subjects ware recruited in medical clinic of Sichuan Provincial People's Hospital during July 26th 2016 to October 12th 2017.
Participants by arm
| Arm | Count |
|---|---|
| Sitagliptin Group Patients in this group will accept Sitagliptin phosphate tablets as their intervention. Specifications: Each tablet 100mg (with sitagliptin dollars). Regimen: The recommended dose is 100mg.QD for 3 months.
Sitagliptin: 100mg.QD for 3 months | 83 |
| Non-T2DM Group Subjects in this group are T2D free. We use their gene information to study SNP differences between T2D patients and non-T2DM people. | 36 |
| Total | 119 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 3 | 0 |
| Overall Study | Lack of Efficacy | 2 | 0 |
| Overall Study | Lost to Follow-up | 3 | 0 |
| Overall Study | Physician Decision | 4 | 0 |
Baseline characteristics
| Characteristic | Sitagliptin Group | Non-T2DM Group | Total |
|---|---|---|---|
| Age, Continuous | 54.0 years STANDARD_DEVIATION 9.7 | 60.6 years STANDARD_DEVIATION 7.26 | 57.1 years STANDARD_DEVIATION 7.9 |
| HbA1c | 8.26 percentage of HbA1c STANDARD_DEVIATION 0.88 | 5.01 percentage of HbA1c STANDARD_DEVIATION 0.67 | 7.24 percentage of HbA1c STANDARD_DEVIATION 1.75 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 83 Participants | 36 Participants | 119 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Female | 28 Participants | 16 Participants | 44 Participants |
| Sex: Female, Male Male | 55 Participants | 20 Participants | 75 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 71 | 0 / 36 |
| other Total, other adverse events | 12 / 71 | 0 / 36 |
| serious Total, serious adverse events | 0 / 71 | 0 / 36 |
Outcome results
Primary
Glycosylated Hemoglobin A1c (HbA1c)
non-T2D subjects only tested HbA1c at baseline. Of the 71 patients who completed the study, 69 collected HbA1c at both baseline and study endpoint, and 2 subjects did not carry out HbA1c measurement for personal reasons.
Time frame: 12 weeks later
Population: non-T2D subjects only tested HbA1c at baseline. Of the 71 patients who completed the study, 69 collected HbA1c at both baseline and study endpoint, and 2 subjects did not carry out HbA1c measurement for personal reasons.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Sitagliptin Group | Glycosylated Hemoglobin A1c (HbA1c) | 6.78 percentage of <HbA1c> | Standard Deviation 0.82 |
Secondary
Change in Blood Glucose
Fasting Blood glucose, the postprandial 0.5-hour,2-hour,3-hour blood glucose were measured at baseline and at study end points, and the difference between baseline and study end points were compared.Participants in Non-T2DM Group were not taking Sitagliptin, so their blood glucose were not measured.
Time frame: Basline and 12 weeks later. Fasting, 0.5h, 2h,3h after take 75g glucose orally.
Population: 71 patients complete the study
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Sitagliptin Group | Change in Blood Glucose | ΔFasting blood glucose | -1.60 mmol/l | Standard Deviation 2.29 |
| Sitagliptin Group | Change in Blood Glucose | Δ0.5h Glucose | -2.18 mmol/l | Standard Deviation 3.11 |
| Sitagliptin Group | Change in Blood Glucose | Δ2h Glucose | -3.49 mmol/l | Standard Deviation 4.45 |
| Sitagliptin Group | Change in Blood Glucose | Δ3h Glucose | -3.45 mmol/l | Standard Deviation 4.36 |
Secondary
Change in C-peptide
Fasting C-peptide, the postprandial 2-hour C-peptide were measured at baseline and at study end points, and the difference between baseline and study end points were compared.The changes in fasting C-peptide, the postprandial 2-hour C-peptide were compared among patients with different genotypes at baseline and at study end points.Participants in Non-T2DM Group were not taking Sitagliptin, so their C-peptide were not measured.
Time frame: Basline and 12 weeks later. Fasting and 2h after take 75g glucose orally.
Population: 71 patients complete the study
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Sitagliptin Group | Change in C-peptide | ΔFasting C peptide | 0.03 ng/ml | Standard Deviation 0.41 |
| Sitagliptin Group | Change in C-peptide | Δ2h C peptide | 1.11 ng/ml | Standard Deviation 1.38 |
Secondary
Change in Insulin
Fasting insulin, the postprandial 0.5-hour,2-hour,3-hour insulin were measured at baseline and at study end points, and the difference between baseline and study end points were compared.The changes in fasting insulin, the postprandial 0.5-hour,2-hour,3-hour insulin were compared among patients with different genotypes at baseline and at study end points.Participants in Non-T2DM Group were not taking Sitagliptin, so their insulin were not measured.
Time frame: Basline and 12 weeks later. Fasting and 0.5h, 2h,3h after take 75g glucose orally.
Population: 71 patients complete the study
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Sitagliptin Group | Change in Insulin | Δ3h insulin | 2.99 μU/ml | Standard Deviation 11.77 |
| Sitagliptin Group | Change in Insulin | ΔFasting insulin | 0.66 μU/ml | Standard Deviation 4.36 |
| Sitagliptin Group | Change in Insulin | Δ0.5h insulin | 4.00 μU/ml | Standard Deviation 8.62 |
| Sitagliptin Group | Change in Insulin | Δ2h insulin | 8.43 μU/ml | Standard Deviation 13 |
Secondary
Types of Gene Polymorphism
24 SNPs genetic points of DPP-4, GLP-1 and GLP-1R.
Time frame: Baseline
Population: All of the participants were detected the 24 SNPs genetic points
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Sitagliptin Group | Types of Gene Polymorphism | rs7565794 | 40.0 percentage of Allele frequency |
| Sitagliptin Group | Types of Gene Polymorphism | rs2111850 | 40.5 percentage of Allele frequency |
| Sitagliptin Group | Types of Gene Polymorphism | rs10166311 | 40.5 percentage of Allele frequency |
| Sitagliptin Group | Types of Gene Polymorphism | rs2284872 | 42.4 percentage of Allele frequency |
| Sitagliptin Group | Types of Gene Polymorphism | rs2300757 | 39.2 percentage of Allele frequency |
| Sitagliptin Group | Types of Gene Polymorphism | rs16822665 | 42.5 percentage of Allele frequency |
| Sitagliptin Group | Types of Gene Polymorphism | rs2302873 | 42.4 percentage of Allele frequency |
| Sitagliptin Group | Types of Gene Polymorphism | rs7608798 | 44.2 percentage of Allele frequency |
| Non-T2DM Group | Types of Gene Polymorphism | rs7608798 | 24.3 percentage of Allele frequency |
| Non-T2DM Group | Types of Gene Polymorphism | rs2284872 | 25.0 percentage of Allele frequency |
| Non-T2DM Group | Types of Gene Polymorphism | rs2111850 | 25 percentage of Allele frequency |
| Non-T2DM Group | Types of Gene Polymorphism | rs16822665 | 25.0 percentage of Allele frequency |
| Non-T2DM Group | Types of Gene Polymorphism | rs7565794 | 29.2 percentage of Allele frequency |
| Non-T2DM Group | Types of Gene Polymorphism | rs10166311 | 24.3 percentage of Allele frequency |
| Non-T2DM Group | Types of Gene Polymorphism | rs2300757 | 25.0 percentage of Allele frequency |
| Non-T2DM Group | Types of Gene Polymorphism | rs2302873 | 25.0 percentage of Allele frequency |