Clinical Evaluation of DPP-4 Inhibitor's Impact on Autonomic Neuropathy Monitored by SUDOSCAN®
A. Syngle, S. Chahal, K. Vohra.
Article title: Efficacy and tolerability of DPP4 inhibitor, teneligliptin, on autonomic and peripheral neuropathy in type 2 diabetes: an open label, pilot study.
Neurological Sciences. 2020 Aug 15.
A new publication by Syngle et al. in Neurological Sciences has shown that the dipeptidyl-peptidase-4 (DPP-4) inhibitor teneligliptin improves sudomotor function and peripheral and autonomic neuropathy, and reduces vascular inflammation in type 2 diabetes independently of its effect on glycemic control.
Twenty type 2 diabetic patients received 20 mg teneligliptin daily as add-on therapy to their usual antiglycemic medications. After 12 weeks of teneligliptin, patients demonstrated statistically significant improvements (p<0.01) in measures of sudomotor and autonomic function which were initially abnormal, mainly Sudoscan feet ESC, heart rate response to standing (HRS) and Valsalva (HRV), and blood pressure response to standing (BPS). Vibration perception threshold (VPT) also significantly decreased (p<0.01). Measures which were normal at baseline (BMI, blood pressure, blood pressure response to handgrip, and heart rate response to deep breathing) were not significantly improved after 12 weeks. Additionally, while fasting blood sugar and HbA1c were significantly lower after treatment with teneligliptin (p<0.01), these changes did not correlate with improvements in autonomic or sudomotor function, suggesting a different mechanism of action.
Effect on various parameters of neuropathy
Conclusions: This study is the first of its kind to examine the clinical effects of the DPP-4 inhibitor, teneligliptin, on autonomic and peripheral neuropathy in type 2 diabetic patients. The study suggests that teneligliptin may enhance the neurotrophic effects of GLP-1 and mitigate the inflammatory process, leading to improvements in peripheral sympathetic autonomic neuropathy, cardiovascular autonomic neuropathy, and peripheral neuropathy. Furthermore, the authors suggest that assessing sudomotor function, which is an early predictor of cardiovascular risk, may help identify diabetic patients who could benefit from DPP-4 add-on therapy. While the results are promising, the authors recommend a larger randomized controlled trial to validate these findings.