Alogliptin: a unique DPP-4 inhibitor that regulates adipose tissue insulin resistance and atherogenic lipids

Abstract

Abstract Objectives This work is to investigate the regulation of adipose tissues insulin resistance with DPP-4 inhibitors in relation to other diabetic parameters in treatment naïve subjects with T2DM. Methods The subjects received alogliptin 12.5–25 mg/day (n = 55), sitagliptin 25–50 mg/day (n = 49) or teneligliptin 10–20 mg/day (n = 43) monotherapy for 3 months. Changes of adipo-IR and some diabetic parameters were analyzed. Results Among these drugs, only alogliptin could significantly reduce adipo-IR (-25.9%) and lipid parameters including LDL-C (-7.8%), T-C/HDL-C (-6.8%), log(TG)/HDL-C (-6.8%), non-HDL-C/HDL-C (-8.7%), LDL-C/HDL-C (-11.2%). The subjects in alogliptin group were divided into two similar numbers of groups with distinct changes (Δ) of adipo-IR (group A: Δadipo-IR=-56.5%, p < 0.00001, n = 28; group B: Δadipo-IR = 19.1%, p = 0.055, n = 27). Comparable, significant reductions of FBG (-14.1%, -15.5%) or HbA1c (10.26–8.93%, 11.04–9.08%) were observed in group A and B, respectively. Significant reductions of HOMA-R (-25.7%), T-C/HDL-C (-10.3%), TG (-18.1%), log(TG)/HDL-C (-11.3%), non-HDL-C/HDL-C (-13.1%), LDL-C/HDL-C (-12.8%) or FFA (-28.9%), and increases of QUICKI (5.9%) or HDL-C (6.9%) were seen in group A. By contrast, significant reductions of QUICKI (-3.8%) or LDL-C (-9.2%), and increases of HOMA-R (28.4%), insulin (55.1%), HOMA-B (106.3%), C-peptide (16.5%) or CPR-index (39.8%) were observed in group B. Conclusion These results indicate that 1) alogliptin, but not other DPP-4 inhibitors, could down-regulate adipo-IR and some atherogenic lipids. To date, this is the first report showing that a DPP-4 inhibitor regulates adipose tissue insulin resistance. 2) adipo-IR is associated with non-LDL-C lipid parameters, but not with glycemic control during treatment of alogliptin. 3) glycemic efficacy of alogliptin is determined by modulation of insulin resistance and beta-cell function.