Title:An Update in Incretin-Based Therapy: A Focus on Dipeptidyl Peptidase - 4 Inhibitors
VOLUME: 8 ISSUE: 3
Author(s):Brian K. Irons, Jessica M. Weis, Megan R. Stapleton and Krystal L. Edwards
Affiliation:Division Head, Ambulatory Care Texas Tech University Health Sciences Center, School of Pharmacy 3601 4th St. Lubbock, TX 79430, USA.
Keywords:Dipeptidyl Peptidase 4 Inhibitors, Incretin, Type 2 diabetes mellitus
Abstract:Dipeptidyl peptidase -4 inhibitors represent a novel way to augment the incretin system and one of the newest
class of medications in the treatment of type 2 diabetes mellitus. Their mechanism of action is to decrease the inactivation
of glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide, both of which are involved in maintaining
euglycemia subsequent to carbohydrate intake. Currently investigated agents include sitagliptin, vildagliptin, saxagliptin,
linagliptin, and alogliptin. Each agent has been shown to provide significant improvements in glycemic control compared
to placebo. They are effective when added to other oral diabetes agents and in the cases of sitagliptin, vildagliptin, and
alogliptin in addition to insulin. These agents may not provide as significant improvement in glucose concentrations as
some other medications including metformin, thiazolidinediones, or glucagon-like peptide 1 agonists. The lack of head to
head clinical data comparing the various dipeptidyl peptidase 4 inhibitors does not allow for specific recommendations if
one agent is more effective or safer than another within the class. Their side effect profile suggests they are very well
tolerated and have few drug interactions. For patients with mildly elevated glucose concentrations, they are therapeutic
options in both drug-naïve patients as well as those not optimally controlled on other diabetes medications.
