scholarly journals Impact of Dipeptidyl Peptidase-4 Inhibitors on Glycemic Control and Cardiovascular Safety with Adherence: An Overview

2019 ◽  
Vol 25 (3-4) ◽  
pp. 90-99
Author(s):  
Keerthanaa Bhavadasan ◽  
Ann Merry Davis ◽  
Bharathi Kolanthavel
Keyword(s):  
Glycemic Control ◽  
Lifestyle Modification ◽  
Glucagon Secretion ◽  
Dipeptidyl Peptidase ◽  
Major Adverse Cardiovascular Events ◽  
Tolerability Profile ◽  
Cardiovascular Safety ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors

Diabetes is a ubiquitous chronic disease worldwide. The prevalence is expected to increase further to 9.9% by the year 2045. Dipeptidyl peptidase-4 (DPP-4) inhibitors, also called as gliptins, act as incretin enhancers. They inhibit glucagon secretion and arouse postprandial insulin secretion, both in a glucose-dependent mode. In 2006, sitagliptin was approved as a first DPP-4 inhibitor in the treatment of diabetes concurrently with lifestyle modification. Sitagliptin has a high bioavailability, while linagliptin has a safety and tolerability profile similar to that of placebo, with a very low risk for hypoglycemia. DPP-4 inhibitors have a weight neutrality effect. One major benefit of gliptins is their excellent tolerability/safety profile compared with other glucose-lowering medications, including other new glucose-lowering agents such as sodium/glucose cotransporter 2 inhibitors. Compared with sulfonylureas, they have a smaller decline in HbA1c. The three gliptins showed excellent effect on glycemic control as an add-on therapy in treating type 2 diabetes. The major adverse cardiovascular events, malignancy and pancreatitis, were not associated with the treatment with sitagliptin, a DPP-4 inhibitor. The objective of establishing cardiovascular safety trials such as SAVOR-TIMI 53, EXAMINE, TECOS, CAROLINA, and CARMELINA. DPP-4 inhibitors have higher rates of adherence and persistence compared with sulfonylureas and thiazolidinediones.

scholarly journals Hypoglycemic Coma in a Hemodialysis Patient Receiving Blood Glucose-Lowering Therapy With the Single Agent Teneligliptin

2018 ◽  
Vol 11 ◽  
pp. 117954761876335 ◽  
Author(s):  
Takumi Minezumi ◽  
Shin-ichi Takeda ◽  
Yusuke Igarashi ◽  
Kentaro Sato ◽  
Yoshiaki Murakami ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Single Agent ◽  
Severe Hypoglycemia ◽  
Dipeptidyl Peptidase ◽  
Hypoglycemic Agents ◽  
Tolerability Profile ◽  
Oral Hypoglycemic Agents ◽  
Dipeptidyl Peptidase 4 ◽  
Hypoglycemic Coma ◽  
Dipeptidyl Peptidase 4 Inhibitors

Blood glucose management in patients undergoing dialysis is clinically challenging. In this population, most conventional oral hypoglycemic agents are contraindicated, especially from the perspective of pharmacokinetics. Dipeptidyl peptidase-4 inhibitors exert unique pharmacologic actions via glucose-dependent mechanism and have an excellent tolerability profile with a very low risk of hypoglycemia. Furthermore, the literature reports that some dipeptidyl peptidase-4 inhibitors such as teneligliptin can be administered at the usual dose, regardless of a patient’s level of renal impairment. In this article, we report a case of hypoglycemic coma with a blood glucose level of 23 mg/dL. The patient became fully conscious shortly after receiving a glucose injection; however, severe hypoglycemia recurred for approximately 1.5 days. It eventually disappeared on the discontinuation of teneligliptin, which was the only antidiabetic agent that he had received. The present case may provide deep insights into promoting the safe use of hypoglycemic agents in patients undergoing dialysis.

scholarly journals Differential diagnosis and treatment of diabetes mellitus associated with Cushig’s disease

2017 ◽  
Vol 14 (2) ◽  
pp. 53-58
Author(s):  
Larisa K. Dzeranova ◽  
Ekaterina E. Bibik ◽  
Ekaterina A. Pigarova ◽  
Taras S. Panevin ◽  
Andrey Yu. Grigor'ev
Keyword(s):  
Diabetes Mellitus ◽  
Differential Diagnosis ◽  
Positive Impact ◽  
Dipeptidyl Peptidase ◽  
Diagnosis And Treatment ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Treatment Of Diabetes

Diabetes mellitus associated with endogenic hypercortisolism is one of the most frequent symptoms of Cushings disease and may mask other implications. Achievement of the diseases remission not always leads to complete involution of its complications. The new glucose-lowering drugs can exert a complex positive impact in patients with hypercortisolemic comorbidities. To treat diabetes mellitus associated with the central hypercortisolism groups of dipeptidyl peptidase 4 inhibitors and sodium-glucose co-transporter-2 inhibitors should be taken into account.

scholarly journals Possible applications of gliptins (dipeptidyl peptidase-4 inhibitors) in patients with type 2 diabetes mellitus on the various modes of insulin therapy

2015 ◽  
Vol 18 (4) ◽  
pp. 87-91 ◽  
Author(s):  
Gagik Radikovich Galstyan ◽  
Svetlana Viktorovna Sergeeva
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Glucagon Secretion ◽  
Insulin Requirement ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors

The evidence for DPP-4 inhibitors effectiveness at the late stages of type 2 diabetes mellitus (T2DM) are still growing. This is particularly important for those patients who receive insulin without adequately glycemic control. This publication provides the overview of studies which demonstrate high efficacy of Vildagliptin in reducing the blood glucose level in patients with hight duration of T2DM and insulin therapy. DPP-4 inhibitors normalize basal and postprandial glucagon secretion with pancreas α-cells that helps to provide better glycemic control and to reduce a risk of hypoglycemia. Besides, there are very interesting data for Vildagliptin to reduce insulin requirement in T2DM patients in addition to HbA1clevel decrease.

scholarly journals Trust and VERIFY: the role of combined treatment with metformin and dipeptidyl peptidase-4 inhibitors in new-onset diabetes type 2

2020 ◽  
Vol 4 (6) ◽  
pp. 334-339
Author(s):  
T.Yu. Demidova ◽  
◽  
A.A. Kozhevnikov ◽  
Keyword(s):  
Combined Treatment ◽  
Diabetes Type 2 ◽  
Dipeptidyl Peptidase ◽  
Diabetes Type ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Glucose Lowering Therapy

Diabetes is a progressive disease that manifests itself in hyperglycemia and is associated with macro- and microvascular complications. Stepwise approach to glucose-lowering therapy is now often questioned for two main reasons. First, the decision on intensifying the treatment requires the decompensation of carbohydrate metabolism. Second, this conception does not always meet the criteria of pathophysiological treatment, in particular, in patients who are newly diagnosed with diabetes type 2 and recommended with metformin monotherapy. The combination of metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors is a well-known strategy that effectively controls blood glucose level and preserves beta cell functions. VERIFY study has demonstrated that after a 5-year follow-up, median time to type 2 diabetes decompensation is 36.1 months in metformin group and 61.9 months in early combined treatment group (metformin plus vildagliptin) (p<0.0001). These findings can account for paradigm shift in treatment prescription for newly diagnosed type 2 diabetes in patients with HbA1c less than 1,0% of the target level.KEYWORDS: diabetes, glucose-lowering therapy, control of glycemia, combined treatment.FOR CITATION: Demidova T.Yu., Kozhevnikov A.A. Trust and VERIFY: the role of combined treatment with metformin and dipeptidyl peptidase-4 inhibitors in new-onset diabetes type 2. Russian Medical Inquiry. 2020;4(6):334–339. DOI: 10.32364/2587-6821-2020-4-6-334-339.

scholarly journals Trends in Glucose Lowering Drug Utilization, Glycemic Control, and Severe Hypoglycemia in Adults with Diabetes in Hong Kong 2002-2016

2020 ◽  
Author(s):  
Aimin Yang ◽  
Hongjiang Wu ◽  
Eric S.H. Lau ◽  
Ronald C.W. Ma ◽  
Alice P.S. Kong ◽  
...  
Keyword(s):  
Hong Kong ◽  
Glycemic Control ◽  
Severe Hypoglycemia ◽  
Population Based ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Patients With Diabetes ◽  
Lowering Drug ◽  
Design And Methods

<b>OBJECTIVE</b> There has been a shift towards new classes of glucose lowering drugs (GLDs) in the past decade but no improvements in glycemic control or hospitalization rates due to severe hypoglycemia (SH) in previous surveys. We examined trends in GLDs utilization, glycemic control and SH rate among patients with diabetes in Hong Kong which introduced a territory-wide, team-based diabetes care model since 2000. <p><b>RESEARCH DESIGN AND METHODS</b> Using population-based data from the Hong Kong Diabetes Surveillance Database, we estimated age- and sex-standardized proportion of GLDs classes, mean hemoglobin A1c (HbA1c) levels and SH rates in 763,809 diabetes patients aged≥20 years between 2002-2016. </p> <p><a><b>RESULTS </b>Between 2002-2016, use declined for sulfonylureas (62.9% to 35.3%) but increased for metformin (48.4% to 61.4%) and dipeptidyl peptidase-4 inhibitors (DPP-4i) (0.01% in 2007 to 8.3%). The proportion of patients with HbA1c of 6.0-7.0% (42-to-53 mmol/mol) increased from 28.6% to 43.4% while SH rate declined from 4.2 per 100-person-years to 1.3 per 100-person-years. The main improvement in HbA1c occurred between 2007 and 2014, decreasing from mean (SD) 7.6 (1.6)% (59.5 [19.0] mmol/mol) to 7.2 (1.7)% (54.8 [18.9] mmol/mol) (p<0.001). The 20-44 age group had the highest proportion of HbA1c≥9% (75 mmol/mol) and rising proportions not on GLDs (from 2.0% to 7.7%).</a></p> <p><b>CONCLUSIONS</b> In this 15-year survey, the modest but important improvement in HbA1c since 2007 coincided with diabetes service reforms, increase in metformin, decrease in sulfonylurea and modest rise in DPP-4i use. Persistently poor glycemic control and under-utilization of GLDs in the youngest group calls for targeted action.</p>

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