Dipeptidyl peptidase 4 (DPP-4) inhibitors for the treatment of type 2 diabetes Mellitus
ABSTRACT: Diabetes mellitus
(DM) is a chronic disease which caused around 1.5 million deaths in 2012. Type
2 diabetes mellitus (T2DM) accounts for 90% of DM worldwide. The prevalence of
T2DM is increasing due to obesity. Clinical guidelines recommend the use of
metformin as the frst-line treatment, followed by the addition of 1 or 2 oral antidiabetic
drugs (OADs), such as sulphonylurea (SU), an alpha-glucosidase inhibitor, or thiazolidinediones
(TZDs). Recently, newer agents such as dipeptidyl peptidase 4 (DPP-4) inhibitors
have been added to those treatment algorithms. The DPP-4 inhibitor is a classof
OAD that inhibits the DPP-4 enzyme. Sitagliptin, saxagliptin, vildagliptin and
linagliptinare DPP-4 inhibitors available for the treatment of T2DM in
Indonesia and many other countries. The DPP-4 inhibitors have similar glycemic
effcacy. However, they produce a moderate improvement in glycated hemoglobin
(A1C). There are limited numbers of head-to-head trials of DPP-4 inhibitors. In
addition, there are no data on the long-term DPP-4 inhibitors use safety (more
than two years), mortality, diabetic complications, or health-related quality
of life. Although DPP-inhibitors are not used as initial treatment for a
majority of patients with T2DM, DPP-4 inhibitors can be used as add-on therapy in
T2DM patients who are intolerant to, have contraindications for, or
uncontrolled with the use of metformin, SU, or TZDs. The exact role of DPP-4
inhibitors among several other agents to manage T2DM is not clear. There are
only a small number of long-term studies on DPP-4 inhibitors assessing the
glycemic decrease effcacy, important clinical outcomes (cardiovascular events,
mortality), or safety. In patients with chronic renal failure considered to use
DPP-4 inhibitors, linagliptin can be recommended. There are inadequate data to
assess the effect of DPP-4 inhibitors on the occurrence of acute pancreatitis.
Overall, DPP-4 inhibitors are well-tolerated.
Keywords : type 2 diabetes mellitus - dipeptidyl peptidase 4 (DPP-4)
inhibitors - sitagliptin, saxagliptin - vildagliptin – linagliptin
Author: Erna Kristin
Journal Code: jpkedokterangg160177
