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SGLT2 and DPP-4 Inhibitors as adjuncts to Metformin.

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eMediNexus Editorial    18 January 2018

A new article published in Diabetes/Metabolism Research and Reviews reported that newer oral therapies for type-2 diabetes (T2DM) – dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium glucose cotransporter 2 (SGLT2) inhibitors, have advantages over older agents. The article elaborated that DPP-4 inhibitors are weight neutral, and have few adverse effects. While SGLT2 inhibitors have added benefits, such as weight loss, blood pressure reduction, cardiovascular risk reduction, and renoprotective effects. The importance of benefit and risks over older treatments was emphasized upon, especially in terms of cost-effectiveness. Moreover, the authors favored the use of SGLT2 inhibitors over DPP4 inhibitors as adjuncts to metformin when glycemic targets have not been achieved, given their comparable glycemic efficacy and the additional benefits of SGLT2 inhibitors. In particular, SGLT2 inhibitors were recommended in patients where additional weight loss and blood pressure reductions are desired, and in those with heart failure or cardiovascular disease. On the other hand, it was sated that DPP-4 inhibitors should be chosen in cases where side-effects of other agents are of concern, in the frail elderly population, and in those with renal disease.

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