From the Research
When transitioning from DPP-4 inhibitors to GLP-1 receptor agonists, no specific time interval is required between discontinuation and initiation. You can stop the DPP-4 inhibitor (such as sitagliptin, saxagliptin, linagliptin, or alogliptin) and start the GLP-1 receptor agonist (like semaglutide, dulaglutide, liraglutide, or exenatide) on the same day without any washout period. This seamless transition is possible because while both medication classes work on the incretin system, they have different mechanisms of action. DPP-4 inhibitors prevent the breakdown of endogenous GLP-1, while GLP-1 receptor agonists directly stimulate GLP-1 receptors with much higher concentrations of GLP-1-like molecules. There is no additive benefit to using both medications simultaneously, which is why the switch is typically made. When initiating GLP-1 receptor agonists, remember to start with the lowest dose and titrate up as tolerated to minimize gastrointestinal side effects like nausea and vomiting. Blood glucose monitoring is recommended during this transition to ensure adequate glycemic control is maintained, as supported by the findings of a network meta-analysis 1.
Key points to consider:
- The most recent and highest quality study, a network meta-analysis from 2021 1, supports the use of GLP-1 receptor agonists for their benefits in reducing cardiovascular mortality and all-cause mortality.
- GLP-1 receptor agonists have a different mechanism of action compared to DPP-4 inhibitors, allowing for a seamless transition between the two without a washout period.
- Initiating GLP-1 receptor agonists at the lowest dose and titrating up as tolerated can help minimize gastrointestinal side effects.
- Blood glucose monitoring during the transition is crucial to ensure maintained glycemic control.