Dipeptidyl Peptidase-4 inhibitors use in type II diabetic patients in a tertiary hospital

Abstract

Background: In Malaysia, for more than a decade, dipeptidyl peptidase-4 inhibitors (DPP-4i) are among the oral antidiabetic medications used as monotherapy or in combination to manage type II diabetes mellitus (T2DM). These medications are known for the efficacy in glycated haemoglobin (HbA1c) reduction and weight neutral effect with minimal hypoglycaemia occurrence. This study aimed to identify the outcomes of DPP-4i use in one of the largest tertiary public hospital in Southeast Asia. Methods: This is a retrospective cross sectional study conducted in 2016, where stratified sampling method was used. Patients with T2DM treated with available DPP-4i; namely Linagliptin, Saxagliptin, Sitagliptin and Vildagliptin, for at least 3 months were identified from the pharmacy record. Medical records from Physician Clinic in Hospital Kuala Lumpur (HKL) were reviewed. Data on demographic, anthropometric, antidiabetic treatment modalities, laboratory and documented outcomes were collected. Outcomes endpoints which include changes in HbA1c, fasting blood glucose (FBG), and body weight were recorded and analysed. Adverse drug reactions (ADR) documented were also reported. Results and discussion: A total of one hundred and five patients were recruited. The patients were 49.5% men (n = 52), with a mean age of 57 years, mean HbA1c of 8.5% (69 mmol/mol) and mean BMI of 29.5 kg/m 2. At least 50% of the patients had T2DM for more than 10 years and more than two third of these patients had both T2DM and hypertension. Thirty nine patients were on Vildagliptin, 32 on Sitagliptin, 26 on Saxagliptin and the remaining on Linagliptin. The most commonly prescribed DPP-4i were Vildagliptin and Sitagliptin. Majority of the patients (90.4%) were prescribed with Metformin, with 62.8% of patients on fixed-dose combination, and the remaining on add-on Metformin therapy. Use of DPP-4i as an adjunct was associated with a mean reduction of 0.9% (9 mmol/ mol) in HbA1c (p < 0.0001) and 1.15 mmol/L (19.82 mg/dL) in FBG (p = 0.001) without significant weight changes (p = 0.745). Sitagliptin had the highest reduction in HbA1c (1.66%,19 mmol/mol; p-value< 0.0001). Twelve ADRs were reported with the highest report on gastrointestinal intolerance (n = 7). None of the ADR reported caused any significant harm to the patients. Conclusion: Overall, use of these DPP-4i as an adjunct antidiabetic was associated with reduction in HbA1c.

Experimental Design Approach for Quantitative Expressions of Simultaneous Quantification of Two Binary Formulations Containing Remogliflozin and Gliptins by RP-HPLC

“…The combination of dipeptidyl peptidase-4 (DPP-4) inhibitors such as vildagliptin (Figure 1A, VLG) and teneligliptin (Figure 1B, TNG) with the sodium-glucose cotrasportase-2 (SGLT-2) inhibitor, remogliflozin etabonate, (Figure 1C, RGE) has just been approved by the Food and Drug Administration for the treatment of diabetes mellitus type 2 [6,7]. DPP-4 inhibitors increase the secretion of insulin by inhibiting the enzyme DPP-4 responsible for degradation of incretins in the blood, thereby decreasing the blood glucose level by lowering the blood glucagon level, and improving pancreatic cell function [8,9]. DDP-4 inhibitors also lower HbA1c levels without causing hypoglycemia and weight gain [10][11][12].…”

Solid-Phase Extraction and Characterization of Quercetrin-Rich Fraction from Melastoma malabathricum Leaves

“…The simulation was then experimentally validated using recombinant DPP-IV in a calorimetric assay. The inhibition of DPP-IV has been proven as an effective and safe therapy for the treatment of type II diabetes mellitus since the last decade [33,34]. The results showed that the antidiabetic property of M. malabathricum was mainly contributed by quercetrin and partly attributed to other plant constituents.…”