Efficacy and Safety of Glimepiride With or Without Linagliptin Treatment in Patients With HNF1A Diabetes (Maturity-Onset Diabetes of the Young Type 3): A Randomized, Double-Blinded, Placebo-Controlled, Crossover Trial (GLIMLINA)

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  • Alexander S Christensen, Steno Diabetes Center, Copenhagen, University of Copenhagen
  • ,
  • Sofie Hædersdal, Steno Diabet Ctr Copenhagen, Steno Diabetes Center, University of Copenhagen
  • ,
  • Julie Støy
  • Heidi Storgaard, Steno Diabet Ctr Copenhagen, Steno Diabetes Center, University of Copenhagen
  • ,
  • Ulla Kampmann
  • Julie L Forman, Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
  • ,
  • Marta Seghieri, Steno Diabetes Center, Copenhagen, University of Copenhagen, Azienda USL Toscana Centro
  • ,
  • Jens J Holst, Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, University of Copenhagen
  • ,
  • Torben Hansen, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen
  • ,
  • Filip K Knop, Steno Diabetes Center, Copenhagen, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, University of Copenhagen
  • ,
  • Tina Vilsbøll, Steno Diabetes Center, Copenhagen, Department of Clinical Medicine, University of Copenhagen

OBJECTIVE: Sulfonylureas are first-line treatment of hepatocyte nuclear factor 1-α (HNF1A) diabetes (maturity-onset diabetes of the young type 3), but many patients do not achieve optimal glycemic control without episodes of hypoglycemia. We investigated the combination of the sulfonylurea glimepiride and the dipeptidyl peptidase-4 inhibitor linagliptin versus glimepiride monotherapy with respect to glycemic variability, glycemic control, and risk of hypoglycemia.

RESEARCH DESIGN AND METHODS: In a randomized, double-blinded, crossover trial, patients with HNF1A diabetes (n = 19; mean ± SD age 43 ± 14 years, BMI 24.8 ± 2.8 kg/m2, and glycated hemoglobin [HbA1c] 7.4 ± 0.2% [57.1 ± 7.3 mmol/mol]) were randomly assigned to treatment with glimepiride + linagliptin 5 mg (16 weeks), washout (4 weeks), and glimepiride + placebo (16 weeks) (or vice versa). Glimepiride was titrated targeting a fasting plasma glucose of 4.5-6.0 mmol/L without hypoglycemia. Treatments were evaluated by continuous glucose monitoring (CGM), HbA1c, and meal test.

RESULTS: Compared with glimepiride + placebo, glimepiride + linagliptin did not significantly improve the primary end point mean amplitude of glycemic excursions (MAGE) (mean difference -0.7 mmol/L, P = 0.1540) but displayed significant reductions in coefficient of variation on CGM (-3.6%, P = 0.0401), HbA1c (-0.5%, P = 0.0048), and glimepiride dose (-0.7 mg/day, P = 0.0099). β-cell glucose sensitivity (assessed as C-peptide-to-glucose ratio) during meal test improved with glimepiride + linagliptin. Incidences of hypoglycemia were similar with both treatments.

CONCLUSIONS: Linagliptin as add-on treatment to glimepiride improved glycemic variability and control without increasing risk of hypoglycemia in patients with HNF1A diabetes.

Original languageEnglish
JournalDiabetes Care
Volume43
Issue9
Pages (from-to)2025-2033
ISSN0149-5992
DOIs
Publication statusPublished - Sep 2020

    Research areas

  • ALPHA, GENES, GLUCOSE, HYPOGLYCEMIA, INHIBITION, INSULIN-SECRETION, MUTATIONS, NUCLEAR FACTOR-1-ALPHA, RISK, SENSITIVITY

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