The Effect of Combination of Mosapride and DPP-4 Inhibitor on Plasma Concentration of Incretin Hormones

This is randomized, double-blind, placebo-controlled, cross-over study. After screening and enrollment, participants will take 5 mg of linagliptin once a day for one week of run-in period (Day 1 to Day 7). Randomization will be done on Day 8 to assign the participants to either mosapride arm or placebo arm. If a subject is assigned to mosapride arm, mixed meal tolerance test (MMTT) will be performed after taking mosapride with linagliptin. If a subject is assigned to placebo arm, he/she will take placebo instead of mosapride before MMTT. On Day 9, all subjects will be crossed over to the other arm and MMTT will proceed with medication depending on their arms. Gastric emptying time measurement with paracetamol will be done along with MMTT. Plasma incretin hormone levels in two arms will be compared.

Inclusion criteria

• type 2 diabetes mellitus
• BMI < 35 kg/m2
• HbA1c 6.5~8.0% for whom is on lifestyle modification only, 6.0~8.0% for whom is taking oral antidiabetic drug(s).
• on lifestyle modification or oral antidiabetic therapy (sulfonylurea, biguanides, thiazolidinediones, alpha-glucosidase inhibitors, and DPP-4 inhibitors)
• Who read and signed the informed consent agreement

Exclusion criteria

• chronic disease(s) requiring medication other than diabetes mellitus
• type 1 diabetes mellitus or history of diabetic ketoacidosis
• on insulin therapy or requiring insulin therapy
• history of gastrointestinal surgery excluding appendectomy, hernia repair and hemorrhoid surgery
• serum aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) to be more than 2.5 times above the upper limit of normal
• estimated glomerular filtration rate to be less than 50 mL/min/1.73m2
• genetic disorders associated with digestion and absorption such as galactose intolerance, Lapp lactase deficiency, and glucose-galactose malabsorption
• history of hypersensitivity including anaphylaxis and angioedema to mosapride citrate, linagliptin, or paracetamol (acetaminophen)
• history of asthma associated with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
• currently taking drugs that can prolong QT interval, including procainamide, quinidine, flecainide, sotalol, tricyclic antidepressants
• currently taking anticholinergics such as atropine sulfate, scopolamine butylbromide
• child-bearing or lactating women
• women in reproductive age who disagree with contraception with proper method or urine pregnancy test during the study period