From the Guidelines
Gliptins, also known as dipeptidyl peptidase-4 (DPP-4) inhibitors, should be used as second-line medications for treating type 2 diabetes when metformin alone is insufficient or not tolerated, particularly in patients at risk of hypoglycemia, elderly patients, those with renal impairment, or patients who cannot tolerate the gastrointestinal side effects of metformin 1.
Key Considerations
- Gliptins are generally well-tolerated with minimal risk of weight gain and hypoglycemia, though they may cause upper respiratory infections, headache, or rare cases of pancreatitis 1.
- They should be used cautiously in patients with a history of pancreatitis or heart failure, as saxagliptin has been associated with increased risk of heart failure hospitalization 1.
- Linagliptin does not require dose adjustment in patients with renal impairment, making it a suitable option for this population 1.
- Gliptins can be used in combination with other antidiabetic medications, including metformin and basal insulin, to achieve better glycemic control 1.
Dosage and Administration
- Common gliptins include sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), and alogliptin (Nesina) 1.
- These medications are usually prescribed at a fixed daily dose (sitagliptin 100mg, saxagliptin 5mg, linagliptin 5mg, or alogliptin 25mg once daily) 1.
Clinical Evidence
- A study published in The Lancet Diabetes and Endocrinology in 2021 found that DPP-4 inhibitors are well-tolerated and effective for glycemic control in patients with type 2 diabetes, with a low risk of hypoglycemia 1.
- Another study published in Circulation in 2019 found that saxagliptin has been associated with increased risk of heart failure hospitalization, and therefore should be used with caution in patients at risk for heart failure 1.
From the FDA Drug Label
Saxagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Gliptin, such as saxagliptin, is used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus 2.
- Key Indication: Type 2 diabetes mellitus
- Key Patient Population: Adults
- Concomitant Therapy: Diet and exercise
From the Research
When to Use Gliptin
Gliptins, such as sitagliptin, saxagliptin, and vildagliptin, are dipeptidyl peptidase-4 (DPP-4) inhibitors used in the treatment of type 2 diabetes mellitus. The decision to use gliptin should be based on the individual patient's needs and medical history.
- As Monotherapy: Gliptins can be used as monotherapy in patients with type 2 diabetes who are not adequately controlled with diet and exercise alone 3, 4, 5.
- As Combination Therapy: Gliptins can be used in combination with other antihyperglycemic agents, such as metformin, sulfonylureas, or thiazolidinediones, in patients who are not adequately controlled with monotherapy 3, 4, 5, 6.
- In Patients with Renal Impairment: Gliptins can be used in patients with renal impairment, but the dose may need to be adjusted based on the patient's renal function 5.
- In Patients with Cardiovascular Disease: Gliptins can be used in patients with established cardiovascular disease, and they have been shown to be noninferior to placebo in terms of cardiovascular safety 5.
Considerations for Use
When considering the use of gliptin, the following factors should be taken into account:
- Efficacy: Gliptins have been shown to be effective in improving glycemic control in patients with type 2 diabetes 3, 4, 5, 6.
- Safety: Gliptins are generally well tolerated, but they can cause adverse events such as hypoglycemia, gastrointestinal disorders, and musculoskeletal disorders 7, 3, 4, 5, 6.
- Drug Interactions: Gliptins can interact with other medications, such as cytochrome P450 inhibitors, and the dose may need to be adjusted accordingly 7.
- Cost: The cost of gliptins can be a consideration, and the decision to use them should be based on the individual patient's needs and medical history.
Comparison of Gliptins
The choice of gliptin should be based on the individual patient's needs and medical history.
- Sitagliptin: Sitagliptin is a commonly used gliptin that has been shown to be effective in improving glycemic control in patients with type 2 diabetes 3, 4, 5.
- Saxagliptin: Saxagliptin is another gliptin that has been shown to be effective in improving glycemic control in patients with type 2 diabetes, but it has a higher potential for drug interactions 7, 6.
- Vildagliptin: Vildagliptin is a gliptin that has been shown to be effective in improving glycemic control in patients with type 2 diabetes, and it has been compared to sitagliptin and saxagliptin in clinical trials 6.