Type 2 Diabetes: Optimizing DPP-4 Inhibitor Therapy


Experts Javier Morales, MD, and Dhiren Patel, PharmD, CDE, BC-ADM, BCACP, share their perspectives on optimizing the use of DPP-4 inhibitors to manage type 2 diabetes, given their personal experience in the clinic and with safety and efficacy profiles.

Javier Morales, MD: We have several DPP-4 inhibitors that have come to the marketplace and are utilized today. One of them actually has become generic, which is kind of interesting. Now, most of these agents need to include dose reduction in patients who may have impaired renal function or a reduced glomerular infiltration, with the exception of 1 called linagliptin. Linagliptin could be used at any stage of renal function quite safely.

In my clinical experience, I find the DPP-4 inhibitors quite easy to use. They’re a tablet form administered 1 time per day, and most patients do report no adverse events with the use of these agents. They are extremely well tolerated and available either as individual DPP-4 inhibitors or in combination with metformin or other glucose-lowering agents.

Dhiren Patel, PharmD, CDE, BC-ADM, BCACP: When counseling patients on DPP-4 inhibitors, there are actually not a lot of things to mention, because this class is really well tolerated. The adverse effects of this class are actually very minimal. You’ll see some nonspecific adverse events, such as headache and diarrhea. There are some warnings regarding acute pancreatitis that can happen with this class of medications. Some upper respiratory tract infections were seen in clinical trials. But for the most part, when I’m talking to patients regarding a DPP-4 inhibitor, there are very minimal side effects if I mention anything to them.

Some of the feedback that I’ve received regarding the DPP-4 inhibitors is the ease of use. For a patient, sometimes oral therapy is something that’s really important for them—being able to be adherent or compliant to that regimen. Other benefits of this class, and this specific medication include a low hypoglycemic risk profile and it being weight neutral. When patients with diabetes are asked what are 2 things that are most important to you, those are the 2 things that always come up: something that is not going to cause weight gain or potentially have this weight-loss profile; and low blood sugars, because that’s not something that’s fun for patients. Anything that has a low-to-no hypoglycemia risk profile is usually more favorable from a patient’s standpoint.

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