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A Decade of DPP4Is: Learning, Unlearning and Relearning

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Dr Shashank Joshi, Mumbai    31 January 2018

  1. efficacy in real life and in Indian patients; works in all stages of diabetes; promise of b-cell regeneration. DPP4i may address insulin resistance.
  2. New learnings with gliptins: Don’t cause hypoglycemia; increase insulin secretion in a glucose-dependent fashion; primarily work by increasing the GLP-1, and to some extent GIP, levels; weight-neutral, no harmful effects on BP; perhaps more useful early in diabetes.
  3. What may have changed: A role in preventing hypoglycemia; a role in insulin synthesis (not just secretion); GIP is more important for long-term action of gliptins. We may need to harness the beneficial effects of gliptins on appetite, obesity markers and BP.
  4. Gliptins are effective both in early and late stage of T2DM. They can be used with insulin conveniently. Gliptin and metformin is slowly becoming the therapeutic standard for T2DM.
  5. DPP4i, SGLT2i and DPP4i+SGLT2i FDCs may become commonplace after metformin in a few years. In 2008, gliptins were a new class with promise of glucose lowering without any additional hazards. Today, gliptins are not just effective and durable antidiabetic drugs; they are much more. They address dysglycemic state with potential benefits related to BP, obesity markers and many other metabolic parameters.

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