From the Guidelines
DPP-4 inhibitors are a suitable treatment option for type 2 diabetes, particularly for patients who cannot tolerate metformin or require second-line therapy, due to their moderate glucose-lowering efficacy and minimal risk of hypoglycemia when used alone 1.
Key Characteristics of DPP-4 Inhibitors
- They work by blocking the enzyme that breaks down incretin hormones, increasing insulin production and reducing glucose production from the liver.
- Common DPP-4 inhibitors include sitagliptin, saxagliptin, linagliptin, and alogliptin, with typical daily doses of 100mg, 5mg, 5mg, and 25mg, respectively.
- These medications are generally well-tolerated, with minimal risk of hypoglycemia when used alone and no significant effect on weight gain.
Clinical Use and Considerations
- DPP-4 inhibitors are often prescribed as second-line therapy after metformin or for patients who cannot tolerate metformin.
- They are particularly useful for elderly patients or those with kidney disease, although dose adjustments may be necessary for some DPP-4 inhibitors in cases of kidney impairment 1.
- Side effects are generally mild and may include upper respiratory infections, headache, and rarely joint pain.
Recent Evidence and Recommendations
- Recent studies have demonstrated the effectiveness of DPP-4 inhibitors in achieving glycaemic control with a low risk of hypoglycaemia in patients with mild-to-moderate hyperglycaemia 1.
- The 2018 American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) consensus report recommends considering DPP-4 inhibitors as part of a patient-centered approach to managing type 2 diabetes 1.
- However, it is essential to consider the potential increased risk of heart failure associated with certain DPP-4 inhibitors, such as saxagliptin and alogliptin, particularly in patients with preexisting heart failure or renal impairment 1.
From the FDA Drug Label
Alogliptin tablets are 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. TRADJENTA 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 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.
DPP-4 medications for diabetes are used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. The medications include:
- Alogliptin 2
- Linagliptin 3
- Saxagliptin 4 These medications are not recommended for the treatment of type 1 diabetes or diabetic ketoacidosis.
From the Research
DPP4 Inhibitors for Diabetes Treatment
- DPP4 inhibitors are a class of oral antidiabetic agents that enhance the body's ability to regulate blood glucose by increasing the active levels of incretins, such as glucagon-like peptide 1 (GLP-1) 5, 6, 7, 8, 9.
- They work by stimulating glucose-dependent insulin secretion and inhibiting glucagon production, resulting in improved glycemic control 5, 6, 7, 8, 9.
Efficacy and Safety
- DPP4 inhibitors have been shown to be effective in reducing hemoglobin A1c (HbA1c) levels by approximately 0.6-1.1% as monotherapy or in combination with other oral antidiabetic agents or basal insulin 5, 6, 7, 8, 9.
- They have a low risk of hypoglycemia and are body weight-neutral, making them a suitable treatment option for patients with type 2 diabetes 5, 6, 7, 8, 9.
- The safety and efficacy of DPP4 inhibitors have been established in various patient populations, including the elderly and those with renal impairment 5, 7.
Clinical Applications
- DPP4 inhibitors can be used as monotherapy or in combination with other antidiabetic agents, such as metformin, sulphonylurea, and thiazolidinediones 5, 6, 7, 8, 9.
- They may also be used in combination with basal insulin, providing an alternative to basal-bolus insulin regimens in hospitalized patients with type 2 diabetes 5.
- Sitagliptin, a DPP4 inhibitor, has been shown to be effective and well-tolerated in various treatment regimens, including as initial therapy and as add-on therapy for patients with type 2 diabetes 9.