From the Guidelines
The recommended dosage of Januvia (sitagliptin) for most adults with type 2 diabetes is 100 mg once daily, taken with or without food, as per the latest guidelines 1. For patients with moderate renal impairment (eGFR 30-45 mL/min), the dose should be reduced to 50 mg once daily, while those with severe renal impairment (eGFR <30 mL/min) should take 25 mg once daily. Treatment with Januvia is typically ongoing as part of a comprehensive diabetes management plan that includes diet, exercise, and possibly other antidiabetic medications. Some key points to consider when using Januvia include:
- Monitoring HbA1c every 3-6 months to assess effectiveness, with a target of less than 7% for most adults 1.
- Januvia works by inhibiting the DPP-4 enzyme, which increases incretin hormone levels, stimulating insulin release and reducing glucagon secretion in a glucose-dependent manner.
- Common side effects include upper respiratory infections, headache, and occasionally gastrointestinal symptoms.
- Patients should be aware that Januvia is not a substitute for insulin in insulin-dependent patients and should report any symptoms of pancreatitis, which is a rare but serious potential side effect 1. It's also important to consider the individualized treatment goals and the presence of other metabolic comorbidities when selecting subsequent glucose-lowering agents 1. A person-centered shared decision-making approach should guide the choice of pharmacologic agents for adults with type 2 diabetes, taking into account factors such as effectiveness, hypoglycemia risk, impact on weight, cost and access, and individual preferences 1.
From the Research
Recommended Dosage and Treatment Plan for Januvia (Sitagliptin)
The recommended dosage and treatment plan for Januvia (sitagliptin) in patients with type 2 diabetes are as follows:
- The primary endpoint of clinical trials was the reduction from baseline in glycosylated haemoglobin (HbA1c) 2
- Sitagliptin is approved as monotherapy and in combination with other antihyperglycaemic drugs for the treatment of adult patients with type 2 diabetes (T2D) 3
- Sitagliptin may be used as monotherapy or in double or triple combination with other oral glucose-lowering agents such as metformin, thiazolidinediones, or sulfonylureas 4
- The long-term efficacy of sitagliptin as either monotherapy or add-on therapy to metformin has been evaluated, showing improvement in glycemic control over 2 years in patients with type 2 diabetes 5
Key Considerations
- Sitagliptin is generally well tolerated, with most adverse events being of mild to moderate intensity and relatively few patients discontinuing treatment because of these events 3
- Sitagliptin treatment was not associated with an increased risk for the known cardiovascular disease (CVD) risk factors of hypoglycaemia and body weight gain 3
- The use of sitagliptin in patients with moderate to severe renal insufficiency requires a lower dosage 6
- Sitagliptin has a low risk of hypoglycaemia, a neutral effect on body weight, and once-daily dosing 4
Clinical Efficacy
- Numerous randomized placebo- or active comparator-controlled trials have demonstrated the efficacy of sitagliptin in terms of improving glycaemic control in patients with type 2 diabetes 2
- Sitagliptin has shown beneficial effects for other endpoints, such as the proportion of patients who achieved target HbA1c, and reductions from baseline in fasting plasma glucose (FPG) levels and 2-h postprandial glucose (PPG) levels 2
- The TECOS CV safety trial in patients with T2D and established CVD showed that sitagliptin was noninferior to placebo in terms of the risk of the 4-point major adverse cardiac event (MACE) outcome, with no increased risk in hospitalization for heart failure 3