Summary: In patients with diabetic foot ulcers, adding oral sitagliptin 100 mg daily to standard care improved healing rates and reduced ulcer area versus standard care alone, alongside higher CD34+ endothelial progenitor cells and SDF-1α, with a non-significant trend toward faster healing.
PICO Summary
| Element | Detail |
|---|---|
| Population | 62 adults with type 2 diabetes and diabetic foot ulcers (open-label, 31 per arm). |
| Intervention | Oral sitagliptin 100 mg once daily added to standard conventional therapy. |
| Comparison | Standard conventional therapy alone. |
| Outcome | Greater reduction in ulcer area and improved healing (p<0.05), with higher CD34+ EPCs and SDF-1α (p<0.05). Healing-time reduction was a trend only (p=0.071). No significant HbA1c difference; no adverse events reported. |
Sitagliptin for diabetic foot ulcer healing
Open-label RCT · type 2 diabetes · diabetic foot ulcers
Adding sitagliptin to standard care produced a greater reduction in ulcer area and improved healing, with higher CD34+ EPCs and SDF-1α. Time-to-healing was only a trend (p=0.071) in this small open-label RCT.
Expert Commentary
The mechanism here is elegant enough to be tempting: DPP-4 degrades SDF-1α, so inhibiting it should raise SDF-1α, mobilise endothelial progenitor cells, and aid healing independent of glucose, and the biomarkers in this trial moved exactly as that story predicts. I find the rationale genuinely attractive, because sitagliptin is familiar, weight-neutral, and low-risk, so a wound-healing co-benefit would be a welcome bonus in a patient who needs an oral agent anyway. My verdict stays cautious, though, because the clinical signal is softer than the mechanism. The headline healing improvement was significant, but the outcome I would most want, time to healing, was only a trend at p equals 0.071, and the rest leans on surrogate cell markers in a small open-label trial with no data on recurrence or amputation. Can I use this with my patients? Cautiously yes, in the narrow sense that if a patient with a foot ulcer needs a DPP-4 inhibitor, this nudges me toward sitagliptin rather than away, but I would never let it displace debridement, offloading, infection control, or vascular assessment. I want a larger trial with hard healing endpoints before claiming more.
References
Gao W, Chen D, He H, Jiang N, Chen L, Ran X. Sitagliptin, a DPP-4 inhibitor, effectively promotes the healing of diabetic foot ulcer: a randomized controlled trial. J Diabetes. 2025;17(9):e70156. doi:10.1111/1753-0407.70156