Combination treatment for type 2 diabetes mellitus (T2DM) : dipeptidyl peptidase-4 inhibitors (DPP-4) and metformin
Abstract: Using the concept of
inhibition of dipeptidyl peptidase-4 (DPP-4) as a new treatment for type 2
diabetes mellitus (T2DM) is based on the inhibition of bioactive peptide
inactivation process. Most clinical trials on DPP-4 inhibition are based on
vildagliptin, sitagliptin, saxagliptin, and linagliptin. The drugs may improve
glycemic control when they are given as a combination with other oral
hyperglycemic agents or when they are given to patients who received metformin
and still had inadequate glycemic control. Studies showed that vildagliptin was
well-tolerated if it was given as add-on treatment to metformin for 24 weeks
duration. In addition, vildagliptin showed significant clinical improvement
proven by the associated decrease in HbA1c and fasting glucose levels.
Sitagliptin in initial combination therapy with metformin decreased HbA1c level
by 2.1% after 24 weeks of treatment. It was reported that DPP-4 inhibitor
saxagliptin increased glycemic control when it was added to metformin. The
study included 743 patients with an average HbA1c level of 8.0% when they were
treated with metformin alone. After 24 weeks of treatment, saxagliptin
decreased HbA1c level by 0.7%. A multicenter, randomized, placebo-controlled,
double-blind, parallel-group study examined the efficacy and tolerability of
linagliptin as treatment adjunctive to metformin in patients T2DM. The primary
end point was changed in HbA1c from baseline to 24 weeks of treatment. The mean
adjusted change from baseline in HbA1c in the linagliptin group was 0.49%
compared with an increase of 0.15% in the placebo group, with 26% and 9% of
participants in the linagliptin and placebo groups, respectively, achieving an
HbA1c 7.0% at 24 weeks. The combination of DPP-4 inhibitors and metformin has
been shown to be well-tolerated with a very low risk of hypoglycemia.
Therefore, DPP-4 inhibitors and metformin combination is an efficient, safe,
and well-tolerated therapy for T2DM.
Keywords: DPP-4 inhibitor –
sitagliptin – vildagliptin – saxgliptin – linagliptin – metformin - type 2
diabetes
Author: Erna Kristin
Journal Code: jpkedokterangg170311
