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Continuing with our medication series today we are discussing the class known as Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors). As with all the posts in this series, this is not advice about whether you should or should not take them. Only how they work and the pros and cons of each medication.

What are DPP-4 Inhibitors

DPP-4 inhibitors are a class of oral diabetes medications used in type 2 diabetes. When you eat your body releases satiety hormones known as incretin hormones. These indicate you are full up and require no more food. Examples of these hormones are Glucagon Like Peptide 1 (GLP-1) and gastric inhibitory polypeptide (GIP). These hormones also slow down the passage of food through your intestines and stimulates the pancreas to produce more insulin after meals.

In type 2 diabetes this helps slow down how much carbohydrate (and thus glucose) enters your blood stream at any one time.

However, the incretin hormones need to be broken down and removed from your circulation to help re-stimulate hunger for your next meal. DPP-4 hormones do the job of removing the incretin hormones from your system by breaking them down. Therefore, DPP-4 inhibitors slow down the action of DPP-4 hormones in removing the incretin hormones. This results in a prolonged post meal state.

This class of medications are known as the gliptins. Examples include:

  • Sitagliptin (Januvia)
  • Linagliptiin (Tradjenta)
  • Alogliptin (Vipidia)
  • Vildagliptin (Galvus)
  • Saxagliptin (Onglyza)

Benefits of using DPP-4 Inhibitors

They are typically only once a day and thus require a low medication burden. You can expect a reduction in your HbA1c between 0.4-1% (5-11mmol/l) over a 12 month period.

Linagliptin does no require any dose adjustment with impaired renal function and therefore can be a good option for such patients.

They are also weight neutral or might even induce a very modest weight loss.

They are safe to use in cardiovascular disease but offer no additional benefit like some other diabetes medications.

Finally, they produce a very low risk of hypoglycaemia and therefore you should not expect hypo’s when taking this medication.

Side effects of using DPP-4 Inhibitors

There are some potential side effects of taking DPP-4 inhibitors. Gastrointestinal problems are the most common due to the way the incretin hormones work in your body. By prolonging the action of these hormones it can cause some upset including nausea, diarrhoea and stomach pain.

Other side effects may also be caused by using DPP-4 inhibitors. We’d encourage to read the label or speak with your medical team if you have any concerns.

When not to use them

Patients with any pancreatic, renal or hepatic impairment may be advised to reduce their dose or stop taking this class of medications. Speak with your medical team if you have concerns.

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