Will sitagliptin (DPP-4 inhibitor) cause glucosuria (glucose in the urine)?

From the Guidelines

Sitagliptin does not cause glucosuria as it works by increasing insulin secretion and reducing glucagon secretion in a glucose-dependent manner, without affecting renal glucose reabsorption. Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor used to treat type 2 diabetes, and its mechanism of action is distinct from SGLT2 inhibitors, which lower blood glucose by causing the kidneys to excrete excess glucose in the urine 1. The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have reported that DPP-4 inhibitors, including sitagliptin, have moderate glucose-lowering efficacy and are well tolerated, with a neutral effect on weight and minimal risk of hypoglycemia when used as monotherapy 1.

Some key points to consider when prescribing sitagliptin include:

• The recommended dose for sitagliptin is determined and needs to be adjusted based on renal function 1
• Sitagliptin can be used alone or in combination with other antidiabetic medications like metformin 1
• Clinical trials have shown that DPP-4 inhibitors, including sitagliptin, reduce HbA1c levels by 0.4% to 0.9% in patients with type 2 diabetes 1
• The use of DPP-4 inhibitors alone does not increase the risk of hypoglycemia and includes a neutral or mild effect on weight gain 1

Overall, sitagliptin is a safe and effective treatment option for type 2 diabetes, and its mechanism of action does not involve causing glucosuria. As reported in the standards of medical care for type 2 diabetes in China 2019, sitagliptin and other DPP-4 inhibitors can be used to reduce HbA1c levels and improve glycemic control in patients with type 2 diabetes 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Sitagliptin and Glucosuria

• The provided studies do not directly address the question of whether sitagliptin causes glucosuria (glucose in the urine) 2, 3, 4, 5, 6.
• Sitagliptin is a DPP-4 inhibitor that increases the amount of circulating incretins, which stimulate insulin secretion and inhibit glucose production, thereby lowering blood glucose levels 2, 3, 4.
• The studies report that sitagliptin improves glycemic control, reduces hemoglobin A1c levels, and does not-desktops or weight gain in patients with type 2 diabetes 2, 3, 4, 6.
• However, there is no mention of the effect of sitagliptin on glucosuria in the provided studies.
• As a result, it is not possible to determine whether sitagliptin causes glucosuria based on the available evidence.

Mechanism of Action

• Sitagliptin works by inhibiting the degradation of incretin hormones, such as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) 3, 4, 5.
• This mechanism of action increases insulin secretion and inhibits glucagon secretion, resulting in improved glycemic control 3, 4, 5.
• The effects of sitagliptin on β-cell function and incretin hormone secretion have been studied, but the relationship between sitagliptin and glucosuria remains unclear 5.

Adverse Events

• The studies report that sitagliptin is well-tolerated, with common side effects including gastrointestinal complaints, hypoglycemia, and body weight gain similar to placebo 2, 3, 4, 6.
• However, glucosuria is not mentioned as a potential adverse event in the provided studies.