The Role of DPP-4 Inhibitors in Type 2 Diabetes Mellitus

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As the incidence of type 2 diabetes is steadily increasing, the demand for treatment options is increasing. Dipeptidyl peptidase-4 inhibitors (DPP-4) are a new class of oral anti-hyperglycemic medications that target the incretin system found in the gut. Evidence has shown that treatment with DPP-4 inhibitors has shown significant reductions in HbA1c and increased pancreatic β-cell function without an increased risk of hypoglycemia. In this document, the pharmacology, clinical efficacy, and incidence of adverse effects will be reviewed in an attempt to target a patient population that would benefit the most from treatment with DPP-4 inhibitors.
The role of DPP-4 inhibitors in type 2 diabetes mellitus management
INTRODUCTION
Type 2 diabetes mellitus is a chronic, progressive disease that currently affects approximately 285 million people worldwide and is estimated to affect 430 million people by 2030.1 As the numbers increase, the demand for effective treatments also increases. In addition to lifestyle modifications, the current recommendation for the first-line treatment for people with new-onset type 2 diabetes mellitus is metformin, an oral anti-hyperglycemic agent. In patients who are currently taking metformin but are inadequately controlled, a second oral agent is typically added on. Several second-line oral anti-hyperglycemic agents are available, including older agents such as sulfonlyureas, glinides, thiazolidinediones, α-glucosidase inhibitors, and amylin agonist (pramlintide), as well as newer agents such as dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists.2 However, the debate on which second-line agent should be used is omnipresent.
In 2006, the first oral DPP-4 inhibi...

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...:1–7.
13. Monami M, Vitale V, Ambrosio ML, Bartoli N, Toffanello G, Ragghianti B, et al. Effects on Lipid Profile of Dipeptidyl Peptidase 4 Inhibitors, Pioglitazone, Acarbose, and Sulfonylureas: Meta-analysis of Placebo-Controlled Trials. Advances in Therapy. 2012 Aug 24;29(9):736–46.
14. Jose T, Inzucchi SE. Cardiovascular effects of the DPP-4 inhibitors. Diabetes and Vascular Disease Research. 2012 Feb 15;9(2):109–16.
15. Monami M, Dicembrini I, Antenore A, Mannucci E. Dipeptidyl Peptidase-4 Inhibitors and Bone Fractures: A meta-analysis of randomized clinical trials. Diabetes Care. 2011 Oct 24;34(11):2474–6.
16. Klarenbach S, Cameron C, Singh S, Ur E. Cost-effectiveness of second-line antihyperglycemic therapy in patients with type 2 diabetes mellitus inadequately controlled on metformin. Canadian Medical Association Journal. 2011 Oct 3;183(16):E1213–E1220.

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