Dr. Ahmed Key points:
- Adolescents taking sitagliptin showed improved blood sugar control, as shown by decreased HbA1c levels and reduced spikes in blood glucose after meals.
- The study indicated a significant decrease in UACR among adolescents treated with sitagliptin, suggesting a potential protective effect on the kidneys.
- Better blood sugar management and less kidney damage could improve the quality of life for teenagers with type 1 diabetes.
Type 1 DM is actually a chronic autoimmune disease that affects several people on a global scale. It is characterized by the elimination of insulin-producing beta cells that are in the pancreas, leading to a deficiency of insulin.
This will eventually result in hyperglycemia (high blood sugar levels) which will lead to multiple organ damage, including kidneys.
Talking of kidneys, diabetic nephropathy is commonly linked to type 1 diabetes, long story short, it can cause complete kidney failure. So, obviously, early intervention is needed to prevent or delay the progression of this condition.
A groundbreaking new study published in Diabetologia has revealed that the DPP-4 inhibitor sitagliptin, when combined with the MiniMed 780G advanced hybrid closed-loop system, can significantly improve glycemic control and early-stage diabetic nephropathy in adolescents with type 1 diabetes.
Facts about diabetic nephropathy:
- Silent killer:
More commonly, this disease is referred to as a ‘silent killer’ because it can develop over time while showing no symptoms. It is similar to a hidden threat inside your body, which slowly harms your kidneys without showing any signs. - Early detection:
It is important for diabetics to get regular check ups and blood tests done to detect any early signs of DN. this wil help you with timely intervention and prevention of disease progression. - Risk factors:
Besides diabetes, other risk factors include high blood pressure, high cholesterol, and smoking. These factors make it more likely to develop and progress. - Proteinuria:
A key sign of diabetic nephropathy is proteinuria, which is the existence of excess protein in the urine [ref]. Because of this, valuable nutrients escape from your body. - Progression:
If left untreated, diabetic nephropathy can lead to kidney failure, which then requires dialysis or a kidney transplant.
Methodology
This open-label, parallel-group, randomized controlled trial was conducted at the Pediatric Diabetes Clinic, Ain Shams University, Egypt.
The study included 46 adolescents aged approximately 14 years with type 1 diabetes, all of whom had been using the MiniMed 780G system for at least 6 months before the trial and had HbA1c levels of 8.5% or less (≤69 mmol/mol).
Participants also had diabetic nephropathy characterized by microalbuminuria. Using a computer-generated randomization sequence, they were divided into two groups of 23 each.
The intervention group got a daily dose of oral sitagliptin (50 mg) for 3 months, while the control group continued with the MiniMed 780G system alone (Advanced Hybrid Closed Loop, AHCL).
The primary outcome measure was the change in urinary albumin-to-creatinine ratio (UACR) after 3 months.
The secondary outcome was the change in stromal cell-derived factor-1 (SDF-1) levels from baseline after the intervention period.
Data from all participants were analyzed, and there were no proper differences between groups in baseline clinical and laboratory characteristics or AHCL settings.
Serum SDF-1 levels were higher in participants with type 1 diabetes compared to healthy controls. At the end of 3 months, the intervention group showed a significant reduction in SDF-1 levels and improved UACR.
Additional improvements included reductions in postprandial glucose, sensor glucose levels, glycemic variability, and daily insulin doses, with an increase in time spent in the target glucose range and insulin-to-carbohydrate ratio. Sitagliptin was well-tolerated, with no reports of severe hypoglycemia or diabetic ketoacidosis.
The importance of early intervention
Diabetic nephropathy is an abnormality of type 1 diabetes that can lead to kidney failure. Early intervention is much needed in preventing or delaying the progression of this condition.
The findings of this research show the potential benefits of combining sitagliptin with advanced insulin pump technology in managing type 1 diabetes and protecting kidney health in adolescents.
Implications for future treatment
This study brings hope for teens with type 1 diabetes and early-stage kidney issues caused by diabetes. Using sitagliptin along with the MiniMed 780G system may be a helpful way to improve blood sugar control and lower the chance of kidney problems.
More research is needed to understand the long-term benefits of this treatment and see if it could help other groups of patients too.
Conclusion
There is no doubt that we get valuable insights and information related to the management of type 1 diabetes and diabetic nephropathy in adolescents from this study.
Therefore, by using a combination of medicines and advanced technology, it may be possible to improve the lifestyle of millions of type 1 diabetics worldwide.
The results indicate that sitagliptin, used together with the MiniMed 780G system, shows promise in improving blood sugar control and lowering the risk of kidney damage in adolescents with type 1 diabetes.
This approach could potentially better their overall well-being and lessen healthcare expenses for them and their families. However, further research is necessary to investigate the long-term benefits of this treatment and its possible use in other groups of patients.
