1. Introduction
hypoglycemia, weight gain, type 2 diabetes, diabetes
HYPOGLYCEMIA, DYSBIOSIS, TYPE 2 DIABETES, DISEASES, DIABETES
These authors contributed equally to this work.The efficacy and safety of medications can be affected by alterations in gut microbiota in human beings. Among antidiabetic medications, incretin-based therapy such as dipeptidyl peptidase 4 inhibitors might affect gut microbiomes, which are related to glucose metabolism. This was a randomized, controlled, active-competitor study that aimed to compare the effects of combinations of gemigliptin–metformin vs. glimepiride–metformin as initial therapies on gut microbiota and glucose homeostasis in drug-naïve patients with type 2 diabetes. Seventy drug-naïve patients with type 2 diabetes (mean age, 52.2 years) with a glycated hemoglobin (HbA1c) level ≥7.5% were assigned to either gemigliptin–metformin or glimepiride–metformin combination therapies for 24 weeks. Changes in gut microbiota, biomarkers linked to glucose regulation, body composition, and amino acid blood levels were investigated. Although both treatments decreased the HbA1c levels significantly, the gemigliptin–metformin group achieved HbA1c ≤ 7.0% without hypoglycemia or weight gain more effectively than did the glimepiride–metformin group (59% vs. 24%; Globally, fewer than 30% of patients with diabetes reach glycated hemoglobin (HbA1c) levels of <7.0% (53 mmol/mol), indicating that there is an unmet medical need for more optimal glycemic diabetes management [Because of their good glucose-lowering efficacy, sulfonylureas have been widely used together with metformin for rapid glucose control in patients with type 2 diabetes [Dipeptidyl peptidase 4 (DPP-4) inhibitors are oral anti-hyperglycemic agents with proven glucose-lowering efficacy that have been developed relatively recently [Dysbiosis of the gut microbiota is now recognized as a major contributor to chronic human diseases, including type 2 diabetes [Gemigliptin is a relatively new DPP-4 inhibitor with proven efficacy and safety in various clinical situations [