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Dipeptidyl peptidase-4 inhibitors in type 2 diabetes

Author : Pierre Allain Date : 2012-4-21

Dipeptidyl dipeptidase-4 inhibitors, also called - gliptines are used for the treatment of type 2 diabetes mellitus.

The BMJ March 2012 published a review of the literature with meta-analysis about dipeptidyl dipeptidase-4 inhibitors, DPP-4 inhibitors. This study leads to the following results:

On glycated haemoglobin level, DPP-4 inhibitors

  • used as monotherapy are less effective than metformin
  • used in combination with metformin are less effective than glucagon-like peptide-1, GLP-1 agonists, and about equivalent to sulfonylureas and pioglitazone (the latter is not marketed longer in France but is in the rest of the world).

On body weight, DPP-4 inhibitors,

  • used as monotherapy, cause lesser weight loss than metformin;
  • used in combination with metformin, they induce more weight loss than sulfonylureas and pioglitazone but lesser than GLP-1 agonists.

The authors conclude that in the type 2 diabetes patients, when metformin alone does not lower sufficiently the level of glycated hemoglobin, DPP- 4 inhibitors prescribed in addition induce a decrease of glycated haemoglobin approximately equivalent to that of sulfonylureas and pioglitazone, without effect on body weigh, but at a higher cost and with uncertainties about their long-term safety.

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