Insulin independence after total pancreatectomy and islet autotransplant (TPIAT) for chronic pancreatitis is limited by a high rate of postprocedure beta cell apoptosis. Endogenous glucagon-like peptide-1 and glucose-dependent insulinotropic peptide, which are increased by dipeptidyl peptidase 4 inhibitor therapy (sitagliptin) may protect against beta cell apoptosis. To determine the effect of sitagliptin after TPIAT, 83 adult TPIAT recipients were randomized to receive sitagliptin (n = 54) or placebo (n = 29) for 12 months after TPIAT. At 12 and 18 months after TPIAT, participants were assessed for insulin independence; metabolic testing was performed with mixed meal tolerance testing and frequent sample intravenous glucose tolerance testing. Insulin independence did not differ between the sitagliptin and placebo groups at 12 months (42% vs. 45%, p = 0.82) or 18 months (36% vs. 44%, p = 0.48). At 12 months, insulin dose was 9.0 (standard error 1.7) units/day and 7.9 (2.2) units/day in the sitagliptin and placebo groups, respectively (p = 0.67) and at 18 months 10.3 (1.9) and 7.1 (2.6) units/day, respectively (p = 0.32). Hemoglobin A1c levels and insulin secretory measures were similar in the two groups, as were adverse events. In conclusion, sitagliptin could be safely administered but did not improve metabolic outcomes after TPIAT.
Bibliographical noteFunding Information:
Research reported in this publication was supported by the American Diabetes Association (1-11-CT-06, PI Bellin) and the National Institute of Diabetes and Digestive and Kidney Diseases (K23 DK084315, PI Bellin) as well as National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114. Supply of study drug was provided by Merck.
© Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons
Copyright 2017 Elsevier B.V., All rights reserved.
- clinical research/practice
- clinical trial
- graft survival
- islet transplantation
- islets of Langerhans