Efficacy of linagliptin and teneligliptin for glycemic control in type 2 diabetic patients with chronic kidney disease: assessment by continuous glucose monitoring; a pilot study.

Introduction: Type 2 diabetes patients complicated by chronic kidney disease (CKD) require restricted use and dose adjustment of orally administered hypoglycemic agents because of renal dysfunction, and treatment is likely to be difficult. Linagliptin and teneligliptin are dipeptidyl-peptidase (DPP)-4 inhibitors that do not require dose adjustment even in type 2 diabetes patients complicated by CKD. The aim of this pilot study was to determine the efficacy of these agents for glycemic control using continuous glucose monitoring (CGM).

Materials And Methods: A randomized crossover study was conducted in 13 type 2 diabetes patients with CKD who maintained glycosylated hemoglobin (HbA) levels at <9 % by diet and exercise and had estimated glomerular filtration rates (eGFRs) <60 ml/min 1.73 m. They were treated with teneligliptin at 20 mg/day or linagliptin at 5 mg/day for 6 days then switched to the other agent for another 6 days. CGM was performed before and during treatment. The primary outcome was changes in mean amplitude of glucose excursions (MAGE).

Results: Mean MAGE was 83.8 ± 34.0 and 82.6 ± 32.6 [±standard deviation (SD)] during treatment with linagliptin and teneligliptin, respectively, with no significant difference between agents. The two agents showed comparable beneficial effects on 24-h mean sensor glucose levels and area under the curve for sensor glucose levels ≥180 mg/dl (AUC ≥180), and their use was associated with comparable incidence of hypoglycemia.

Conclusions: Linagliptin and teneligliptin have comparable effects on MAGE in type 2 diabetes patients with CKD and are potentially useful and safe for treatment of such patients.