Teneligliptin is a recently developed oral dipeptidyl peptidase 4 inhibitor indicated for the management of type 2 diabetes mellitus (T2DM) in adults along with diet and exercise. Teneligliptin has been recently available in Japan (Teneria®), Argentina (Teneglucon®), and India (Tenepure; Teneza) at relatively affordable price. This is a positive step toward the management of T2DM in developing countries, where the cost of medicine is out-of-pocket expenditure and is a limiting factor for health care. This review evaluates the efficacy and safety of teneligliptin in the management of T2DM. Teneligliptin has been systematically evaluated in T2DM as monotherapy with diet and exercise and in combination with metformin, glimepiride, pioglitazone, and insulin in short-term (12 weeks) and long-term (52 weeks) studies. These studies have reported a reduction in HbA1c of 0.8%–0.9% within 12 weeks of therapy. Two 52-week studies reported sustained improvement in glycemic control with teneligliptin. Teneligliptin has been found to be well tolerated, and the safety profile is similar to other dipeptidyl peptidase 4 inhibitors. Hypoglycemia and constipation are the main adverse events. Teneligliptin can be administered safely to patients with mild, moderate, or severe renal impairment or end-stage renal disease without dose adjustment. Similarly, it can be used in patients with mild-to-moderate hepatic impairment. Teneligliptin is effective and well tolerated and may have an important role in the management of T2DM.

Most of the insulin formulations in clinical use contain phenol, meta-cresol or both as excipients. These excipients in insulin preparations provide stability and have antimicrobial properties. However, they are reported to be associated with undesirable side-effects especially localised allergic reactions. Amount of excipients injected per unit dose of insulin is a major determining factor in causation of these reactions. This review discusses the excipients in different insulin formulations available in India with potential of precipitating undesirable effects and the use of concentrated insulins to reduce these complications. To avoid the detrimental effects associated with excipients, removal of preservatives or use of insulin preparations devoid of excipients can be an option. Besides these approaches, one approach that can be considered is the use of concentrated insulin to reduce the volume of insulin dose and thereby the excipients. Concentrated insulins address the high insulin requirements of the growing population of patients with type 2 diabetes who require higher insulin doses. Concentrated insulins help in reduction of dose volume as well as amount of excipients injected per unit dose of insulin. U200 (concentrated r-DNA Human Insulin Premix 30/70-200 IU/ml) can be advantageous with better absorption from smaller quantity injected, lesser variability in absorption, lesser pain and discomfort due to smaller quantity, lesser chances of hypoglycaemia all of which can lead to better patient compliance. Thus, concentrated insulin U200 can be one of the alternatives to prevent/reduce clinical complications with excipients in insulins.

Background: Teneligliptin was recently approved for type 2 diabetes (T2D) management in India and is used as monotherapy or in combination with different antidiabetic drugs. The aim of this study was to identify patients’ characteristics associated with better glycemic response to teneligliptin and metformin.Methods: A retrospective analysis of data was performed in patients of T2D with HbA1c above 7% who were treated with teneligliptin 20 mg/d as add on to metformin (500-100 mg/d) and whose follow-up data at 12-weeks was available. Fasting blood sugar (FBS) and post-prandial blood sugar (PPBS) changes were analysed.  Results: Among 66 patients included in analysis, mean age was 61.0±9.8 years and 53% were females. Median duration of diabetes was 2 years. At 12-weeks, a significant reduction PPBS was observed (mean change: -14.3 mg/dL, p=0.009) but not in FBS (mean change: -2.4 mg/dL, p=0.353). Among different patients’ characteristics, age ≤60 years (p=0.006), duration of ≤1 year (p=0.023), body-mass index ≥25 kg/m2 (p=0.009), presence of dyslipidemia (p=0.05) and absence of complications (p=0.012) were associated with significant reduction in PPBS but not in FBS.Conclusions: A younger, newly-diagnosed, obese T2D patients with dyslipidemia without any complications of diabetes can derive better therapeutic effectiveness from teneligliptin added to metformin. These findings need to be confirmed in large, prospective, long duration study.

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