Simonsen et al. alogliptin was administered for steroid diabetes. Levels of markers related to glucose metabolism were measured before alogliptin treatment and after alogliptin treatment, before the prednisolone dose was reduced. Results Alogliptin treatment significantly increased plasma glucagon-like peptide-1 (GLP-1) levels from 1.161.71 pmol/L to 4.481.53 pmol/L and significantly reduced levels of plasma glucose recorded 2 h after lunch and hemoglobin A1c (HbA1c). No significant differences were seen in insulin secretory ability of homeostasis model assessment (HOMA) (HOMA-) and insulin resistance index of HOMA (HOMA-R) before and after alogliptin treatment. In contrast, alogliptin treatment significantly decreased plasma glucagon levels, from 116.138.7 pg/mL to 89.617.3 pg/mL. Moreover, there were significant correlations among HbA1c, GLP-1, Cyantraniliprole D3 and glucagon levels. Conclusions Alogliptin improves steroid-induced hyperglycemia by decrease of glucagon levels through an increase in plasma GLP-1 levels. strong class=”kwd-title” Keywords: Alogliptin, Dipeptidyl Peptidase-4 Inhibitor, HOMA-, HOMA-R, Steroid Diabetes Background Chronic kidney disease (CKD) is a serious risk factor for end-stage renal failure as well as cardiovascular diseases [1,2], and a strategy to counteract this condition must be established urgently. When immunological abnormalities underlie the development of CKD, patients are administered immunosuppressant drugs, including steroids. Steroid diabetes is a major adverse effect of steroid therapy [3], and long-term use of steroids is associated with an elevated risk of developing diabetes mellitus, with the odds ratio ranging from 1.4 to 2.3 [4C6]. The mechanisms underlying the development of steroid diabetes include increases in gluconeogenesis, hepatic glucose output, and insulin resistance, and reports suggest that steroid diabetes is characterized by normal levels of fasting plasma glucose (FPG) and postprandial hyperglycemia [7]. Although insulin therapy is the only compellingly effective treatment for steroid diabetes, it can be difficult to administer insulin to patients with steroid diabetes because of their refusal to use the therapy, reduced visual acuity, or orthopedic impairment. Oral antidiabetic drugs effective in the treatment of steroid diabetes include -glucosidase inhibitors and thiazolidinediones [8,9]. However, the evidence that supports the effectiveness of these drugs in the treatment of steroid diabetes is not conclusive because the studies were small Cyantraniliprole D3 and lacked a detailed investigation of the drugs mechanisms of action. Dipeptidyl peptidase-4 (DPP-4) inhibitors form a drug category developed for the treatment of diabetes mellitus with a new mechanism of action. DPP-4 inhibitors prevent the inactivation of incretin that is released from the gut after food ingestion; incretin, in turn, stimulates insulin secretion [10,11]. Glucagon-like peptidase-1 (GLP-1) is a potent insulinotropic agent that is qualified for the designation of incretin. Alogliptin is a novel quinazolinone-based DPP-4 inhibitor with selectivity for DPP-4 that is more than 10,000-fold greater than that shown by the closely related serine proteases DPP-2, DPP-8, DPP-9, fibroblast activation protein/seprase, prolyl endopeptidase, and tryptase [12]. Alogliptin can be used to treat patients with moderate-to-severe renal failure by adjusting the dose administered. However, only 1 1 case report has suggested that DPP-4 inhibitors may be effective in the treatment of steroid diabetes [13]. Furthermore, the mechanism of action of DPP-4 inhibitors in the treatment of steroid diabetes is unclear. This study investigated the mechanism of action and effectiveness of the DPP-4 inhibitor alogliptin in the treatment of CKD patients with steroid diabetes. Material and Methods Patients and study protocol This study was approved by ethics committee of Hamamatsu University School of Medicine and was conducted in accordance with the Declaration of Helsinki. All CKD patients provided written informed consent. We studied Japanese CKD patients treated with steroids who were admitted to our hospital between January 2012 and December 2012. Those who fulfilled the Cyantraniliprole D3 following criteria were recruited for the study: (1) age, 20 years; (2) absence of Cyantraniliprole D3 the symptoms associated with diabetes mellitus before steroids were administered, including thirst, polyposia, polyuria, and body weight (BW) loss; (3) FPG levels 126 mg/dL, plasma glucose levels 2 h after lunch (2-h PG) 200 mg/dL, and hemoglobin A1c (HbA1c) 6.1% (the Japanese Diabetes Society standard) before steroid administration; and (4) FPG levels 126 mg/dL, 2-h PG levels 200 mg/dL, and/or HbA1c 6.1% after steroid administration. The patients were started on DPP-4 inhibitor, alogliptin for steroid diabetes. The patients who received other drugs for diabetes mellitus, except for alogliptin, were excluded from this study. Upon initiation of alogliptin treatment, baseline values for plasma glucose, HbA1c, immunoreactive insulin, GLP-1, glucagon levels, and serum DPP-4 levels were measured and compared with the values recorded just before the prednisolone dose was reduced. These markers were measured before breakfast and plasma glucose levels were also measured 2 h after lunch. Alogliptin dose The alogliptin dose was adjusted based on renal function as follows: Rabbit Polyclonal to PML patients with an estimated glomerular filtration rate (eGFR) 50 Cyantraniliprole D3 mL/min/1.73 m2 were given 25 mg alogliptin once a day;.