Efficacy and Safety of Sitagliptin in Patients With Type 2 Diabetes and ESRD Receiving Dialysis: A 54-Week Randomized Trial

Background: Treatment with oral antihyperglycemic agents has not been well characterized in patients with type 2 diabetes and end-stage renal disease (ESRD). The efficacy and safety of sitagliptin and glipizide monotherapy in patients with type 2 diabetes and ESRD on dialysis therapy were assessed in this study. Study Design: 54-week, randomized, double-blind, parallel-arm study. Setting & Participants: From 31 clinical sites in 12 countries, 129 patients 30 years or older with type 2 diabetes and ESRD who were on dialysis therapy and had a hemoglobin A(1c) (HbA(1c)) level of 7%-9% were randomly assigned 1: 1 to treatment. Intervention: Monotherapy with sitagliptin, 25 mg daily or glipizide (initiated with 2.5 mg daily and titrated up to a potential maximum dose of 10 mg twice daily or down to avoid hypoglycemia). Outcomes: Primary end points were 54-week change in HbA(1c) level from baseline and tolerability with sitagliptin. A secondary end point was the comparison of sitagliptin versus glipizide on the incidence of symptomatic hypoglycemia. Results: Of 129 patients randomly assigned, 64 were in the sitagliptin group (mean baseline age, 61 years; HbA(1c), 7.9%) and 65 were in the glipizide group (mean baseline age, 59 years; HbA(1c), 7.8%). After 54 weeks, the least squares mean change from baseline in HbA(1c) level was -0.72% (95% CI, -0.95% to -0.48%) with sitagliptin and -0.87% (95% CI, -1.11% to -0.63%) with glipizide, for a difference of 0.15% (95% CI, -0.18% to 0.49%). The incidences of symptomatic hypoglycemia and severe hypoglycemia were 6.3% versus 10.8% (between-group difference, -4.8% [95% CI, -15.7% to 5.6%]) and 0% versus 7.7% (between-group difference, -7.8% [95% CI, -17.1% to -1.9%]) in the sitagliptin and glipizide groups, respectively. Higher incidences (ie, 95% CI around between-treatment difference excluded 0) of cellulitis and headache were found with sitagliptin compared to glipizide (6.3% vs 0%, respectively, for both). Limitations: Small sample size limits between-group comparisons. Conclusions: Treatment with sitagliptin or glipizide monotherapy was effective and well tolerated over 54 weeks in patients with type 2 diabetes and ESRD who were receiving dialysis. Am J Kidney Dis. 61(4): 579-587. (C) 2013 by the National Kidney Foundation, Inc.