Alogliptin: a new dipeptidyl peptidase-4 inhibitor with potential anti-atherogenic properties

Objectives: The aim of this study is to evaluate the effects of alogliptin on metabolic profiles in relation to those of glycemic control. Patients and methods: Treatment naive subjects with type 2 diabetes received 12.5-25 mg/d alogliptin monotherapy (n = 59). A novel parameter called A1c index was used to assess the glycemic efficacy. The subjects were divided into three groups according to this index; super-responders, average responders and poor-responders. At 3 months, levels of the metabolic parameters were compared with those at baseline between super-responders (n = 20) and poor-responders (n = 21). Results: At baseline, total cholesterol, non-high density lipoprotein cholesterol and atherogenic index were significantly higher in super-responders than poor-responders. At 3 months, significant increases of beta-cell function (HOMA-B) and decreases of insulin resistance (HOMA-R) or these atherogenic lipids were observed in super-responders, while significant increases of HOMA-R were observed in poorresponders. Significant correlations were observed between A1c index and the changes of these atherogenic lipids. In super-responders, significant correlations were observed between the changes (Delta) of glycemic parameters (A1c index or fasting blood sugar) and Delta HOMA-R and/or Delta HOMA-B, while in poor-responders, significant correlations were observed between Delta HOMA-R and Delta HOMA-B. Lean subjects gained weight and the changes of body mass index had significant negative correlations with A1c index. Conclusions: These results indicate that (1) glucose lowering efficacy of alogliptin is closely linked to atherogenic lipids. (2) alogliptin can down-regulate atherogenic lipids. (3) glycemic efficacy of alogliptin appears to be determined by the balance of its capacity in modulating insulin resistance and beta-cell function.