What is the use of Sitagliptin (Januvia)?

From the Guidelines

Sitagliptin should be used with a maximum dose of 50 mg daily for patients with moderate kidney impairment and 25 mg once daily for those with severe kidney impairment, as recommended by the most recent guidelines 1. When considering the use of sitagliptin for patients with type 2 diabetes, it's essential to take into account the patient's kidney function. Sitagliptin is a DPP-4 inhibitor that helps control blood sugar levels by increasing incretin hormone levels, which stimulate insulin release after meals and reduce glucagon secretion.

• The standard dosage of sitagliptin is 100 mg once daily, but this may need to be reduced for patients with kidney impairment.
• According to the 2022 consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) 1, the recommended dose adjustments for sitagliptin are as follows:

• Maximum 50 mg daily for patients with stage 3b chronic kidney disease (eGFR 30-44 mL/min/1.73 m2)
• Maximum 25 mg once daily for patients with stage 4 chronic kidney disease (eGFR 15-29 mL/min/1.73 m2)

• Sitagliptin can be used alone or in combination with other diabetes medications like metformin, and it has a neutral effect on weight and minimal risk of hypoglycemia when used as monotherapy 1.
• Regular monitoring of kidney function is recommended while taking sitagliptin, especially for patients with pre-existing kidney impairment.
• It's also important to note that sitagliptin has demonstrated cardiovascular safety in clinical trials, but no cardiovascular benefit has been shown 1.

From the Research

Overview of Sitagliptin

• Sitagliptin is a dipeptidyl peptidase-4 inhibitor used in the treatment of type 2 diabetes mellitus 2, 3, 4, 5.
• It works by increasing the amount of circulating incretins, which stimulate insulin secretion and inhibit glucose production 2.

Efficacy of Sitagliptin

• Sitagliptin has been shown to be effective in improving glycemic control in patients with type 2 diabetes, with significant reductions in glycosylated hemoglobin (HbA1c) levels 2, 3, 4, 5.
• It can be used as monotherapy or in combination with other antidiabetic agents, such as metformin or thiazolidinediones 2, 3, 4, 5.
• Sitagliptin has been shown to be noninferior to other antidiabetic agents, such as glipizide and metformin, in terms of reducing HbA1c levels 3, 4.

Safety and Tolerability of Sitagliptin

• Sitagliptin is generally well tolerated, with common side effects including gastrointestinal complaints, such as abdominal pain, nausea, and diarrhea 2, 3, 4, 5.
• It has a low risk of hypoglycemia, except when used in combination with other agents that may increase the risk of hypoglycemia 3, 4, 5.
• Sitagliptin is also weight-neutral, meaning it does not cause significant weight gain or loss 3, 4, 5.

Use in Special Populations

• Sitagliptin can be used in patients with moderate to severe renal insufficiency, including those with end-stage renal disease on dialysis 6.
• It is also effective in patients with type 2 diabetes and established cardiovascular disease, with no increased risk of major adverse cardiac events 5.