-Gliptin

MOA

• Inhibiting DPP-4, the enzyme that breaks down incretin hormones (glucagon-like peptide-1 and glucose-dependent insulinotropic peptide) which are released after a meal. Therefore increases the amounts of these hormones in the body. Incretins accumulate and delay gastric emptying, increase insulin secretion and reduce glucagon secretion

indication: T2DM

Contraindication: nil

Route: PO

Frequency: All are given once daily except vildagliptin (given once or twice daily).

Side effects:

• Well tolerated
• Not associated with weight gain or hypoglycaemia
• ADRs include headache, musculoskeletal pain

Notes:

• DPP-4 inhibitors result in a small reduction in HbA1c of 0.6 to 0.8%. This reduction is in addition to the effect of other glucose-lowering medicines.
• DPP‑4 inhibitors appear to have no significant effect on patient weight.
• DPP-4 inhibitors did not improve cardiovascular outcomes in trials involving people with or at high risk of cardiovascular disease.
• The DPP-4 inhibitors are usually considered as alternative add-on therapy in patients who cannot tolerate a sulfonylurea (due to problematic hypoglycaemia, weight gain or other adverse effects or if contraindicated)