Dried blood spot testing for estimation of renal function and analysis of metformin and sitagliptin concentrations in diabetic patients: a cross-sectional study

  • Maike Scherf-Clavel
  • Edwin Albert
  • Stephan Zieher
  • Anagnostis Valotis
  • Thomas Hickethier
  • Petra HöggerEmail author
Pharmacokinetics and Disposition



Dried blot spot (DBS) analysis of drugs or clinical parameters offers many advantages. We investigated the feasibility of using DBS for analysis of anti-diabetic drugs concomitantly with the estimated creatinine clearance (Clcrea).


The cross-sectional study involved physicians in an enabling analysis with 70 diabetic patients and community pharmacists in a field investigation with 84 participants. All 154 DBS samples were analyzed for creatinine, metformin, and sitagliptin.


The diabetic patients revealed of a wide range of age (32–88 years), BMI values (19.8–54.7 kg/m2), and extent of polypharmacotherapy (1–21 drugs). A correlation factor to convert capillary blood creatinine from DBS into plasma concentrations was determined. Patients’ Clcrea ranged from 21.6–155.9 mL/min. The results indicated statistically significant correlations (p < 0.05) between the use of two or three particular drug classes (diuretics, NSAIDs, renin-angiotensin system blockers) and a decreased renal function. DBS concentrations of metformin ranged between 0.23–4.99 μg/mL. The estimated elimination half-life (t ½) of metformin was 11.9 h in patients with a ClCrea higher than 60 mL/min and 18.5 h for diabetics with lower ClCrea. Sitagliptin capillary blood concentrations ranged between 11.12–995.6 ng/mL. Calculated t ½ of sitagliptin were 8.4 h and 13.0 h in patients with a ClCrea above and below 60 mL/min, respectively.


DBS allow for the analysis of concentrations of predominantly renally eliminated drugs and community pharmacists can provide a valuable contribution to DBS sampling.


Metformin Sitagliptin Creatinine Clinical study Dried blood spots Capillary blood 



The authors would like to thank the patients and all 14 engaged community pharmacies for their participation in this study. The excellent technical assistance of Sabrina Rösel (office of Drs. Albert and Zieher) is gratefully acknowledged.

Compliance with ethical standards

Patients were recruited and enrolled in the study after written informed consent. The study was approved by the ethics committee of the Medical Faculty of the University of Würzburg (reference number 287/14) and the Freiburg Ethics Committee International (FEKI) and registered by ISRCTN (ISRCTN14518136).

Conflict of interests

The authors declare that they have no conflict of interest.

Supplementary material

228_2019_2637_MOESM1_ESM.docx (283 kb)
Figure S1 (DOCX 283 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Maike Scherf-Clavel
    • 1
  • Edwin Albert
    • 2
  • Stephan Zieher
    • 2
  • Anagnostis Valotis
    • 3
  • Thomas Hickethier
    • 4
  • Petra Högger
    • 1
    Email author
  1. 1.Institut für Pharmazie und LebensmittelchemieUniversität WürzburgWürzburgGermany
  2. 2.Gemeinschaftspraxis, Ärzte für Allgemeinmedizin, DiabetologieMarktheidenfeldGermany
  3. 3.Stabsstelle MedizinsicherheitUniversitätsklinikum WürzburgWürzburgGermany
  4. 4.Stabsstelle BetriebsarztUniversitätsklinikum WürzburgWürzburgGermany

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