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Difference between observed and predicted glycated hemoglobin at baseline and treatment response to vildagliptin-based dual oral therapy in patients with type 2 diabetes

  • Jun-Sing Wang
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

    Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Yi-Jen Hung
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
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  • Yung-Chuan Lu
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan

    School of Medicine for International Students, I-Shou University College of Medicine, Kaohsiung, Taiwan
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  • Cheng-Lin Tsai
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal medicine, Tungs’ Taichung Metroharbor Hospital, Taichung, Taiwan
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  • Wei-Shiung Yang
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Ting-I Lee
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Department of General Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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  • Ya-Chun Hsiao
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital Hsinchu branch, Hsinchu, Taiwan
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  • Wayne Huey-Herng Sheu
    Correspondence
    Corresponding author at: Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Boulevard, Taichung 407, Taiwan.
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

    Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Institute of Medical Technology, College of Life Science, National Chung-Hsing University, Taichung, Taiwan

    School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Published:February 11, 2018DOI:https://doi.org/10.1016/j.diabres.2018.02.002

      Abstract

      Aim

      We aimed to investigate the association of difference between observed and predicted glycated hemoglobin (dopHbA1c) and HbA1c reduction after vildagliptin-based oral therapy in patients with type 2 diabetes (T2D).

      Methods

      This was a prospective observational study. Adults ≥ 20 years old with T2D and HbA1c ≧7% treated with oral anti-diabetic drugs (OADs) were eligible if their OADs were shifted to vildagliptin-based dual oral therapy. Fasting plasma glucose (FPG) and HbA1c were recorded at baseline, week 12, and week 24. To determine baseline dopHbA1c, a predicted HbA1c was calculated by inserting baseline FPG into a regression equation (HbA1c = FPG ∗ 0.0225 + 4.3806) developed from linear relationship between HbA1c and FPG in an independent cohort of 3239 outpatients with T2D (dopHbA1c = observed HbA1c – predicted HbA1c). Patients were assigned to low (≦0) or high (>0) dopHbA1c group according to their baseline dopHbA1c levels. The study endpoint was changes from baseline to week 24 in HbA1c levels.

      Results

      A total of 1224 patients were enrolled. Patients with a dopHbA1c >0 had a greater HbA1c reduction after vildagliptin-based dual oral therapy than those with a dopHbA1c ≦0 (−1.5 ± 2.0 vs. −0.4 ± 1.0%, p < 0.001). Baseline dopHbA1c was positively associated with HbA1c reduction from baseline to week 24 (β coefficient 0.883, 95% CI 0.811 to 0.955, p < 0.001), and the association remained significant after adjustment for confounders.

      Conclusions

      In T2D patients with an HbA1c ≧7%, a higher baseline dopHbA1c was associated with a greater HbA1c reduction after shifting to vildagliptin-based dual oral therapy.

      Keywords

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