The current role of gliptins in the management of type 2 diabetic patients


Authors: Ubomíra Fábryová
Authors‘ workplace: MetabolKLINIK s. r. o., Ambulancia pre diabetológiu, poruchy látkovej premeny a výživy, MED PED centrum, Bratislava 1;  Biomedicínske centrum Slovenskej Akadémie Vied, Bratislava 2;  Vysoká škola zdravotníctva a sociálnej práce sv. Alžbety, Inštitút prevencie a intervencie, Bratislava 3
Published in: Forum Diab 2022; 11(3): 129-134
Category: Review Article

Overview

The current philosophy of antidiabetic treatment in type 2 diabetic patients is based on recently published results of clinical studies aimed at testing cardiocerebrovascular and renal morbidity and mortality and the safety of newer drugs for the treatment of type 2 diabetes mellitus. The new therapeutic recommendations of the Slovak Diabetes Association and the Slovak Diabetes Society published in 2021 detail the hierarchy of therapeutic groups as they should be used in clinical practice in the continuity of current knowledge. Metformin remains the first choice. GLP-1 RAs (glucagon-like peptide-1 receptor agonists) and SGLT-2i (sodium-glucose cotransporter 2 inhibitors) are in the first preferred position of choice with metformin. We prefer these groups of pharmaceuticals not only because of the significant improvement in glycemic compensation, low risk of hypoglycemia and beneficial effect on weight reduction, but mainly because of the confirmed cardiovascular, cerebrovascular and renal benefits. In case of intolerance or contraindication to GLP-1 RA or SGLT-2i, cardiovascular neutral DPP-4 inhibitors (dipeptidyl peptidase- 4 inhibitors) are listed in second place (sitagliptin, linagliptin). DPP-4 inhibitors are important oral antidiabetic agents that have no risk of hypoglycemia and are weight neutral. They should be used as second-line therapy to metformin in type 2 diabetics without pre-existing cardiovascular disease. DPP-4 inhibitors can also be administered in a triple combination with metformin and SGLT-2 inhibitors or with metformin and insulin. Combination with GLP-1 RA is not recommended because DPP-4 inhibitors as well as GLP-1 RA increase plasma concentrations of GLP-1. The side effect profile of DPP-4 inhibitors is favorable, there are few treatment-limiting adverse events, and DPP-4 inhibitors have demonstrated cardiovascular safety. Another favorable characteristic of DPP-4 inhibitors is their efficacy and safety profile in patients with impaired renal function.

Keywords:

DPP-4 inhibitors – linagliptin – sitagliptin – alogliptin – CARMELINA – CAROLINA – EXAMINE – Savor-TIMI-53 – saxagliptin – TECOS – therapeutic algorithm – vildagliptin


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Diabetology Endocrinology Internal medicine
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