There is evidence regarding potent possibilities to improve the EPCs capacity using various methods, i.e. More recent studies only show results in patients with less advanced hepatic disease [139,141143]. Study record managers: refer to the Data Element Definitions if submitting registration or results information. Despite these promising results received in animal and clinical studies, there is not clear whether the EPCs functionality could be restore completely and the circulating number of EPCs would be achieved the level of healthy individuals. You have reached the maximum number of saved studies (100). It is also indicated as add-on to insulin (i.e., triple combination therapy) as an adjunct to diet and exercise to improve glycaemic control in patients when stable dose of insulin and metformin alone do not provide adequate glycaemic control. 20 in postmenopausal women and older men, common side effects of pioglitazone (e.g., Avandamet [rosiglitazone + metformin] is considered 2-drug components); Up to 3 The site is secure. Metformin reduces the absorption of sugar from the stomach, reduces the release of stored sugar from the liver, and helps your body use sugar better. Your doctor may gradually increase your dose until your blood sugar is The .gov means its official. Type 1 diabetic patients must use insulin injections. 1993 Sep 30;329(14):977-86 Angioedema (swelling of the face, lips, tongue, throat, arms, or legs), history with this medication or other dipeptidyl peptidase-4 (DPP-4) inhibitorsUse with caution. All of the SGLT2 inhibitors elicit effects on weight loss, usually 13kg, which represents about 23% of BW and goes along with the intended mechanism of reducing metabolic excess by excreting glucose. The patient was not allowed any food by mouth and was managed with intravenous fluids, antiemetics, and insulin. Though toxicity is rare, but occurs more frequently in cases of intentional or unintentional overdose of these drugs. However, 1.8mg (27%) and 1.2mg (21%) liraglutide treatment group had higher incidence of nausea than 100mg sitagliptin (5%). The hope is that adding SGLT1 inhibition would not only increase glucosuria from the kidney but also prevent glucose absorption from the diet triggering incretin responses, and this could substantially increase the potential weight loss. World Trade CenterMoll de Barcelonas/n, Edifici Est 6 planta08039 BarcelonaSpain, 31/08/2022 Sitagliptin / Metformin hydrochloride Accord - EMEA/H/C/005850 - IAIN/0001. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. Sitagliptin/metformin fixed-dose combination in type 2 diabetes mellitus: an evidence-based review of its place in therapy. Any queries concerning reproduction and rights should be sent to [emailprotected]We acknowledge the provision of funding from the Australian Government Department of Health and Aged Care to develop and maintain this website. in patients whose blood glucose levels are not satisfactorily controlled with metformin (a diabetes medicine) used on its own; in patients who are already taking a combination of sitagliptin and metformin as separate tablets; in combination with a sulphonylurea, a PPAR-gamma agonist such as a thiazolidinedione, or insulin (other types of diabetes medicines) in patients whose blood glucose levels are not satisfactorily controlled with either of these medicines and metformin. Sitagliptin does not work when blood glucose levels are low. 12 Metformin is most often associated with diarrhea, nausea, vomiting, flatulence, abdominal discomfort, indigestion, asthenia, and headache. Drugs R D. 2022 Mar;22(1):15-23. doi: 10.1007/s40268-021-00371-2. 2013 May 7;2(1):67-71. doi: 10.3109/21556660.2013.801605. Please enable it to take advantage of the complete set of features! sharing sensitive information, make sure youre on a federal Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. 1998 Sep 12;352(9131):837-53 Epub 2016 Apr 1. In monotherapy, liraglutide was found as efficient as lifestyle interventions to improve NAFL, fasting glycemia and IR assessed by the homeostatic model assessment of insulin resistance (HOMA-IR) [141]. For this medicine, the following should be considered: Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Interestingly, add-on cotherapies such as sitagliptin, metformin, and sulfonylureas tend to reduce or actually reverse the beneficial effect of SGLT2 inhibition on BP. In these cases, your doctor may want to change the dose, or other precautions may be necessary. GI side-effects were more frequent in patients treated with metformin, both in monotherapy (11.6% versus 2.5% with gliclazide MR and 4% with rosiglitazone) and in combination therapy (12.3% with metformin and gliclazide MR, 10% with metformin plus rosiglitazone, and 3.3% with gliclazide MR and rosiglitazone). Diabetes Obes Metab. By increasing levels of incretin hormones in the blood, sitagliptin stimulates the pancreas to produce more insulin when blood glucose levels are high. Weakened physical conditionUse with caution. eCollection 2013. Exenatide 5-g twice daily was administered to patients for a week after which 10-g twice daily was given for another week. WebIn this study, we compare two strategies: initial combination therapy with sitagliptin/metformin as a fixed-dose combination (FDC) and initial metformin monotherapy, with the option to add additional antihyperglycaemic agents (AHAs) in either treatment arm during the second phase of the study in order to reach adequate glycaemic Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. The .gov means its official. Why Should I Register and Submit Results? Talk with your doctor and family members or friends about deciding to join a study. Disclaimer, National Library of Medicine Sitagliptin / Metformin hydrochloride Accord received a marketing authorisation valid throughout the EU on 22 July 2022. Because the patient's HbA1c was going up, he was again put on dapagliflozin (10mg). CT scan showed findings suggestive of acute pancreatitis. Margaux Nawrot, Bart Staels, in Metabolism, 2021. In addition, metformin has no effect on GIP. Insulin is needed less frequently and HbA1c is lowered more robustly There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. View this study on Beta.ClinicalTrials.gov, U.S. Department of Health and Human Services, The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Latest news, evidence and CPD opportunities. Thus, when compared to sulphonylurea as add-on to metformin, sitagliptin showed substantially lower risk of hypoglycaemia (5%) than glipizide (32%).46 When combined with sulphonylurea, GLP-1 receptor agonists show increased risk of hypoglycaemia.10 This has been observed also for DPP-4 inhibition. Similarly, two other case reports described the occurrence of empagliflozin-induced pancreatitis patients with Type 2 DM (Dziadkowiec et al., 2021 [A]; Zeidan et al., 2020 [A]). Mayo Clinic does not endorse companies or products. Keywords: Diabetes, Ramadan, Fasting, Hypoglycemia Background Ramadan is a lunar-based month lasting between 29 30 days. A pooled analysis for sitagliptin in monotherapy showed that the incidence of hypoglycaemia was 1.2% after treatment with sitagliptin at 100mg daily versus 0.9% in the placebo group.1 Also as add-on therapy to metformin, DPP-4 inhibition shows a low degree of hypoglycaemia. The use of sitagliptin/metformin (sitaformin), a combination of sitagliptin and metformin, has been shown to decrease hemoglobin A1c (HbA1c) and increase homeostasis model assessment (HOMA)-B more significantly than metformin or sitagliptin alone, due to the complementary and possibly additive effects of metformin and sitagliptin [11]. Some studies have reported very interesting facts about metformin, such as its capacity to induce mucin expression similar to Akkermansia muciniphila [40]. In this study, the triple therapy group (metformin+sitagliptin+acarbose) showed a significant decrease in glucagon AUC after 16 weeks of treatment when compared to baseline (4726.17415.80 vs 3314.38191.63ng/min/L, P=0.004). HHS Vulnerability Disclosure, Help 2009 Feb;25(2):93-7. doi: 10.1016/S1607-551X(09)70047-6. Metformin reduces the absorption of sugar from the stomach, reduces the release of stored sugar from the liver, and helps your body use sugar better. Sapna Sharma, Prabhanshu Tripathi, in The Journal of Nutritional Biochemistry, 2019. This content does not have an Arabic version. An independent peer-reviewed journal providing critical commentary on drugs and therapeutics. By continuing you agree to the use of cookies. By now, the results of the recently performed investigations have shown that EPCs dysfunction in DM remains to be unresolved yet. Bo Ahrn MD, PhDProfessor, in Best Practice & Research Clinical Endocrinology & Metabolism, 2009. Clinicians noticed the patient's appearance was suggestive of acromegaly. The UK Prospective Diabetes study shows a 32% risk reduction for diabetes-related death and a 44% reduction for stroke when patients are under tight BP control.90 A comprehensive compilation of BP effects for different SGLT2 inhibitors during the course of clinical trials suggests reductions in both systolic and diastolic BP of 35mmHg and 13mmHg, respectively.91,92 This reduction in BP is likely due to inhibition of SGLT that increases Na+ on the luminal side of the proximal tubule and promotes osmotic diuresis leading to a reduction in plasma volume and an increase in urine output. endothelial cell phenotype), it is possible that a broader derangement of immature EPCs predisposes to CV complications in DM [85]. This is a decision you and your doctor will make. Pharmacologic Class: Sitagliptin Chemical Class: Metformin Uses for sitagliptin and metformin Metformin and sitagliptin combination is used to treat high blood sugar levels caused by type 2 diabetes. SitMet500 FDC / Sit + Met850 / Sit + Met500 / SitMet850 FDC, Experimental: 3. Common adverse reactions are upper respiratory tract infection, nasopharyngitis, and headache. In total, 64.06% of BP patients were anti-BP180 autoantibody positive, 58.97% were combination with metformin, sulfonylureas, thiazolidin-ediones, and/or basal insulin because they are not typi- A double-blind, randomized, crossover, multicenter study was conducted by DeFronzo and coworkers to compare the effectiveness of exenatide versus sitagliptin in subjects with T2DM currently receiving metformin therapy (DeFronzo et al., 2008). 2010 May;12(5):442-51 -, Clin Pharmacol Ther. To better manage his Type 2 DM, dapagliflozin (10mg) was added to the patient's medications. It is available in 25-, 50-, and 100-mg tablets. Our COVID-19 information hub has important information for everyone, including resources about vaccines and treatments. Curr Drug Saf. This helps lower the blood sugar level. 2017 Sep;96(39):e8161. The https:// ensures that you are connecting to the Sitagliptin helps to control blood sugar levels by increasing substances in the body that They also have few pharmacological interactions and a low risk of hypoglycemia, making coadministration an attractive therapeutic prospect. Metformin helps in metabolism and the gut microbiota. Therefore, based on the aforementioned evidence, we suggest that the use of sitaformin may be more effective than individual metformin or sitagliptin treatments in reducing insulin resistance and improving the metabolic profile, ovulation, and comorbid conditions in patients with PCOS. From: Annual Reports in Medicinal Chemistry, 2013, Laura A. Schalliol, Sidhartha D. Ray, in Side Effects of Drugs Annual, 2018. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. The FDA has approved an extended-release, once-daily, dipeptidyl-4 (DPP-4) inhibitor in combination with metformin for adults with type 2 diabetes. Chow, in International Review of Cell and Molecular Biology, 2016. manufacturing authorisationholder responsible for batch release (annex IIA); It is indicated as an adjunct to diet and exercise to improve glycaemic control in patients inadequately controlled on their maximal tolerated dose of metformin alone or those already being treated with the combination of sitagliptin and metformin. Thus, when sitagliptin was added to ongoing glimepiride, there was an increased incidence of hypoglycaemia (12% vs. 2% in the group given glimepiride alone).51 Furthermore, when vildagliptin was added to glimepiride, a slight increase in the incidence of hypoglycaemia was reported (1.2% vs. 0.6% during treatment with glimepiride alone)50; Therefore, a reduced dose of DPP-4 inhibitors or sulphonylureas is suggested when these are used in combination. aerobic exercise, lipid lowering drugs, ACE inhibitors, calcium channel blockers, antidiabetic drugs including metformin, sitagliptin [8792]. This is a generic medicine, which is developed to be the same as a medicine that has already been authorised, called the reference medicine. For more information about using Sitagliptin/Metformin hydrochloride Accord, see the package leaflet or contact your doctor or pharmacist. Accessibility Efficacy and safety of treatment with sitagliptin or glimepiride in patients with type 2 diabetes inadequately controlled on metformin monotherapy: a randomized, double-blind, non-inferiority trial. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. G. Bebernitz, in Comprehensive Medicinal Chemistry III, 2017. Copyright 2023 Elsevier B.V. or its licensors or contributors. TITRATE metformin dose slowly to reduce Efficacy and safety of the dipeptidyl peptidase-4 inhibitor, sitagliptin, in patients with type 2 diabetes mellitus inadequately controlled on glimepiride alone or on glimepiride and metformin. A recent rat study showed that combination therapy with sitaformin ameliorates PCOS through the upregulation of long noncoding RNA H19 (lncRNA H19) [12]. Though toxicity is rare, but occurs more frequently in Used together, sitagliptin (Januvia) and metformin (Glucophage) help to improve glycemic levels in diabetic patients, suggesting a synergy between the agents. Epub 2007 Jun 26. Drug information provided by: IBM Micromedex. Participants were administered treatment in the following sequence with a minimum 7 day washout period between treatments: Choosing to participate in a study is an important personal decision. Metformin and Sitagliptin are often used in combination in the management of non-insulin dependent diabetes mellitus. Sitagliptin/Metformin hydrochloride Accord is a medicine used to control blood glucose (sugar) levels in adults with type2 diabetes. The patient was discharged and placed on the following medications: insulin and metformin. The very small number of adverse side effects in subjects with sitagliptin treatment provides evidence for their potential space in clinical usage. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. Sitagliptin plus metformin and glipizide plus metformin lowered HbA(1c) levels by generally similar magnitudes, with the noninferiority of sitagliptin plus metformin to glipizide plus metformin being established in one 52-week study. Subjects taking 1500mg or greater metformin at screening will enter a 6 week stable dose period followed by a 54 week treatment period. It is indicated as triple combination therapy with a peroxisome proliferator-activated receptor gamma (PPAR) agonist (i.e., a thiazolidinedione) as an adjunct to diet and exercise in patients inadequately controlled on their maximal tolerated dose of metformin and a PPAR agonist. PMC However, elderly patients are more likely to have age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving metformin and sitagliptin combination. Metformin, being advantageous in controlling hyperglycemia without inducing side effects like hypoglycemia or weight gain or any cardiovascular complication, is the first choice for clinicians to treat T2D patients [36]. This is of advantage at high glucose levels. Seven days after the initiation of dapagliflozin, the patient again presented to the emergency room with symptoms of pancreatitis. Generic name: Sitagliptin and Metformin Tablets [ sit-a-GLIP-tin-& met-FOR-min ] Brand name: Janumet Drug class: Antidiabetic combinations Medically reviewed by Drugs.com. May increase the risk of this condition occurring again. Janumet XR is a new formulation of the sitagliptin/metformin combination that is taken once daily with the evening meal. As part of triple combination therapy, also in treatment-experienced patients with inadequate glycaemic control, sitagliptin added to ongoing glimepiride with or without metformin or ongoing insulin with or without metformin significantly improved glycaemic control over 24 weeks. Independent peer-reviewed journal providing critical commentary on drugs and therapeutics for health professionals, Provides health professionals with timely, independent and evidence-based information, Our new and ongoing programs for healthcare professionals. Drug Des Devel Ther. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. In doing so, side effects with either drug can also be identified and assessed more easily. 2016 Sep;42(4):290-1. doi: 10.1016/j.diabet.2016.03.005. The site is secure. WebUsed together, sitagliptin (Januvia) and metformin (Glucophage) help to improve glycemic levels in diabetic patients, suggesting a synergy between the agents. Metformin and sitagliptin may also Baseline endogenous glucose production prior to a mixed meal tolerance test (placebo) and following 6 weeks of either sitagliptin, metformin or sitagliptin plus metformin combination therapy in all 16 participants Average of Plasma Glucose During Mixed Meal Tolerance Test (MTT) Compared to Baseline Plasma Glucose to Post Therapy (6-weeks). Authors hypothesized that SGLT2 inhibitors may possibly precipitate ketoacidosis in patients with active acromegaly and diabetes mellitus due to the additive effects of both conditions on free fatty acid and ketone-body metabolism [51A]. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. Fixed-dose combination medications - count each component as an individual medication. Radiologic procedures (eg, X-rays, CT scans, and MRIs) that require dyes to be injected into your veinThis medicine should be stopped before you have one of these procedures. Because uncommitted progenitor cells can differentiate toward the several phenotypes (i.e. Methods Twenty-six patients with poorly controlled type 2 diabetes currently taking high-dose glimepiride ( 2 Sitagliptin/Metformin hydrochloride Accord is available as tablets and can only be obtained with a prescription. Suspected side effects reported with Sitagliptin/Metformin hydrochloride Accord are carefully evaluated and any necessary action taken to protect patients. The use of sitagliptin/metformin (sitaformin), a combination of sitagliptin and metformin, has been shown to decrease hemoglobin A1c (HbA1c) and increase homeostasis model assessment (HOMA)-B more significantly than metformin or sitagliptin alone, due to the complementary and possibly additive effects of metformin and sitagliptin [ 11 ]. Sitagliptin/metformin is a single-tablet, fixed-dose combination of the dipeptidyl peptidase-4 inhibitor sitagliptin and the biguanide antihyperglycaemic metformin that achieves greater improvements in glycaemic control than either component alone in patients with type 2 diabetes mellitus. Initial dose for patients receiving metformin: sitagliptin 100 mg in combination with current daily metformin dose orally once a day. Bethesda, MD 20894, Web Policies WebThe most common adverse effects associated with sitagliptin include upper respiratory infections, nasopharyngitis, and headaches. government site. Publication No. Whereas this is insufficient BW reduction as a registrable endpoint for an obesity indication, it certainly plays a part in risk reduction from a cardiovascular and diabetic standpoint. The presence of other medical problems may affect the use of this medicine. Would you like email updates of new search results? Mayo Clinic does not endorse companies or products. However, some patients may be taking other -, Diabetes Obes Metab. Unable to load your collection due to an error, Unable to load your delegates due to an error. Sitagliptin/metformin is a single-tablet, fixed-dose combination of the dipeptidyl peptidase-4 inhibitor sitagliptin and the biguanide antihyperglycaemic metformin that achieves greater improvements in glycaemic control than either component alone in patients with type 2 diabetes mellitus. PMC Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Congestive heart failure, acute or unstable or, Hypoxemia (decreased oxygen in the blood) or, Shock (low blood pressure, poor blood circulation) or. Exenatide, however, reduced the caloric intake to a greater extent (134 vs +130kcal) and had a significantly greater effect on the insulinogenic index and reduction in glucagon content. The active substances in Sitagliptin/Metformin hydrochloride Accord each have a different mode of action to help correct this. Clipboard, Search History, and several other advanced features are temporarily unavailable. Intravenous fluid and insulin replacement resulted in rapid metabolic recovery. Your doctor may gradually increase your dose until your blood sugar is controlled. Expert opinion: Achieving optimum blood glucose control is crucial in avoiding or at least delaying the progression of complications related to diabetes. Generic name: Sitagliptin and Metformin Tablets [ sit-a-GLIP-tin-& met-FOR-min ] Brand name: Janumet Drug class: Antidiabetic combinations Medically reviewed by Giampietro O, Giampietro C, Bartola LD, Masoni MC, Matteucci E. Drug Des Devel Ther. 1 and Table 3). AUC (0-t) is the area under the curve for the plot showing plasma concentration against time from time zero to the time of the last quantifiable concentration for sitagliptin 50 mg, metformin 500 mg and metformin 850 mg. Cmax is the peak serum concentration of a therapeutic drug after administration; and is used to determine the rate and extent of drug absorption. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Metformin and sitagliptin is a combination medicine that is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus. In combination with metformin, both sitagliptin and vildagliptin appear to be well tolerated, with low rates of study discontinuation (69,103,104). Acute metformin overdose: examining serum pH, lactate level, and metformin concentrations in survivors versus nonsurvivors: a systematic review of the literature. After 12 weeks of treatment, all doses of sitagliptin resulted in a strong reduction in HbA1c levels ranging from 0.38% to 0.77% with 50-mg twice daily producing the greatest effect. However, the cost of sitagliptin and the need for more data may restrict its use. Here, we present a case of an intentional overdose of a metformin- sitagliptin combination (70g metformin and 3500mg sitagliptin) in a suicide attempt by a young non-diabetic female who presented with severe lactic acidosis and was successfully treated with prompt hemodialysis and bicarbonate therapy. Concerns have been raised, however, regarding potential adverse side effects as a result of prolonged inhibition of DPP-4 activity or off- target actions due to nonselectivity (105-108). Type 1 diabetesShould not be used in patients with these conditions. 14 When sitagliptin and metformin are administered in combination, the most A double-blind, placebo-controlled, randomized multicenter study that took place in Korea included 165 participants. Magnetic resonance imaging revealed a macroadenoma. Metformin and Sitagliptin are often used in combination in the management of non-insulin dependent diabetes mellitus. Make sure you tell your doctor if you have any other medical problems, especially: Portions of this document last updated: Jan. 01, 2023. The https:// ensures that you are connecting to the Sitagliptin under the trade name Januvia (Merck) was the first agent developed in the class of DPP-4 inhibitor approved by FDA in Oct. 2006. Advise patients who are switching to the combination tablets to return their separate medicines to a pharmacy for disposal. The authority-required listing for sitagliptin (Januvia) has been revised and is now streamlined to be consistent with the listing for Janumet.1, Sitagliptin with metformin fixed-dose combination tablets should be taken twice daily with meals.2 If necessary, increase the dose gradually so as to minimise gastrointestinal side effects with metformin.2, Individualise the starting or switching dose according to the patient's current regimen, level of glycaemic control and tolerability, while maintaining a daily dose of sitagliptin of 100 mg/day.2, The initial dose for patients who are inadequately controlled on metformin is sitagliptin 50 mg twice daily plus the previous dose of metformin.2, For patients who are already taking sitagliptin and metformin, a fixed-dose combination tablet may be prescribed at the dose of each medicine that was used separately.2. Though toxicity is rare, but occurs more frequently in cases of intentional or unintentional overdose of these drugs. As a result of the glucose-lowering effects of sitagliptin and metformin treatments, these enhanced insulin secretor responses occurred at lower glucose concentrations. Sitagliptin/metformin is a single-tablet, fixed-dose combination of the dipeptidyl peptidase-4 inhibitor sitagliptin and the biguanide antihyperglycaemic metformin that Nanoemulsion formulations (especially nanoemulsion containing metformin HCl and repaglinide combination) have a better antidiabetic activity and are more effective in reducing oxidative stress caused by diabetes. It is used together with diet and exercise in the following ways: in patients whose blood glucose levels are not satisfactorily controlled with metformin (a diabetes medicine) used on its own; in patients The more medicines you take, the more difficult it can be to remember important information about them. Sitagliptin, however, increases both GLP-1 and GIP concentrations. The maximum dose of sitagliptin is 100 mg a day. A 2020 Cochrane systematic review did not find enough evidence of reduction of all-cause mortality, serious adverse events, cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke or end-stage renal disease when comparing metformin monotherapy to meglitinide for the treatment of type 2 diabetes. Areas covered: This article reviews the history of incretins, the pathophysiology of diabetes and the use of sitagliptin and metformin combination therapy. The mechanism of action of dapagliflozin-induced pancreatitis is unclear. Uses Before taking Warnings Side effects Overdose Dosage Warning Rarely, metformin may cause an acid health problem (lactic Sit + Met500 / SitMet500 FDC / SitMet850 FDC / Sit + Met850, Experimental: 2. metformin and sitagliptin is not for treating type 1 diabetes. Scheen AJ, Charpentier G, Ostgren CJ, Hellqvist A, Gause-Nilsson I. Diabetes Metab Res Rev. 2005 Dec;78(6):675-88 Eligibility Criteria Go to Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. sharing sensitive information, make sure youre on a federal DPP-4 inhibitor monotherapy with sitagliptin did not improve hepatic steatosis in a two-year clinical trial [138]. Epub 2009 Jun 25. Subsequently, the patient did not have any further episodes of pancreatitis over the next 9 months. Metformin reduces the absorption of sugar from the stomach, Sitagliptin as add-on therapy in insulin deficiency: biomarkers of therapeutic efficacy respond differently in type 1 and type 2 diabetes.