Diabetes Medicine: DPP-4 Inhibitors

We keep working our way[1] through all[2] of the diabetes medicines[3] that are available[4]. No matter how you feel about taking medicine to help manage your diabetes, you have to admit that today, in the year 2021, there are a lot of options to choose from! Are any of them perfect? No. Do they have side effects? Yes. But the point is that you have options. Granted, you may not tolerate a particular medicine or perhaps your health plan doesn’t cover the cost, and those are issues of concern. But chances are, in the whole mix of meds, there are one or two that will help you better manage your blood sugars.

This week, we’ll look at a much newer class of medicines called DPP-4 inhibitors.

What are DPP-4 inhibitors?

In 2006, the FDA approved a diabetes medicine from a brand-new class called DPP-4 inhibitors. DPP-4 stands for “dipeptidyl peptidase-4,” a type of enzyme. They’re also called “gliptins.” Sitagliptin (brand name Januvia) was the first drug in this class to be approved. To understand how DPP-4 inhibitors work, it helps to take a step back. When we eat, a type of hormone called incretin is released. Incretins, such as GLP-1, signal the body to release insulin, which, as you know, helps to lower blood sugar. Incretins also inhibit the release of glucagon[5] from the pancreas. Glucagon is a hormone that works to raise blood sugar.

When the body makes incretins, DPP-4 removes them. This process works fine for people who don’t have type 2 diabetes[6], but it’s not a desirable action in people who do have diabetes. So the DPP-4 inhibitors work to block the enzyme and help the incretins do their job of triggering insulin[7] release to lower blood sugar. Studies show that DPP-4 inhibitors can lower A1C by 0.5% to 0.8%.

There are now other DPP-4 inhibitors besides sitagliptin: saxagliptin (Onglyza), linagliptin (Tradjenta), and alogliptin (Nesina). These drugs also come combined with other medicines, like metformin and pioglitazone; brand names include Janumet, Jentadueto, Kazano, Komboglyze and Oseni. Now discontinued, Juvisync was a combination of sitagliptin and simvastatin, which is a cholesterol-lowering medicine.

How are DPP-4 inhibitors taken?

DPP-4 inhibitors are taken once a day, with or without food. They come in varying doses, depending on the type you take.

What are the side effects of DPP-4 inhibitors?

The main side effects of DPP-4 inhibitors include upper respiratory tract infections, headaches, skin rash, facial swelling and urinary tract infections[8] (mostly linked to taking saxagliptin).

Gastrointestinal symptoms, such as diarrhea and nausea, may occur, too. These medicines have been linked with an increased risk for pancreatitis, which is a very serious condition that requires immediate attention. If you take a DPP-4 inhibitor and have severe stomach pain that may be accompanied by nausea and vomiting, seek medical attention right away.

What else should you know about DPP-4 inhibitors?

These medicines are usually prescribed as second- or even third-line forms of therapy; in other words, your doctor will likely first prescribe a drug such as metformin or a sulfonylurea before turning to a DPP-4 inhibitor.

DPP-4 inhibitors don’t cause low blood sugars, but you are at risk for lows if you take them along with a drug that can cause hypoglycemia[9], such as a sulfonlyurea.

DPP-4 inhibitors may reduce your appetite, which can be beneficial if you’re trying to lose weight.

If you take a DPP-4 inhibitor and are planning a pregnancy or become pregnant, talk with your doctor as to whether you should continue taking this medicine or switch to something else. DPP-4 inhibitors are not recommended for women who are nursing.

These medicines can expensive and as such, may not be covered by your health plan. Check into your coverage if your doctor prescribes one of them for you.

Want to learn more about the role of medicines in treating diabetes? Read the rest of diabetes educator Amy Campbell’s eight-part series on diabetes drugs, covering metformin[10], sulfonylureas[11], meglitinides[12], thiazolidinediones[13], SGLT2 inhibitors[14], alpha-glucosidase inhibitors[15], bile acid sequestrants and dopamine receptor agonists[16], non-insulin injectable diabetes medications[17], and insulin[18].

Endnotes:
  1. working our way: https://dsm.diabetesselfmanagement.com/blog/diabetes-medicine-metformin/
  2. through all: https://dsm.diabetesselfmanagement.com/blog/diabetes-medicine-sulfonylureas/
  3. of the diabetes medicines: https://dsm.diabetesselfmanagement.com/blog/diabetes-medicine-meglitinides/
  4. that are available: https://dsm.diabetesselfmanagement.com/blog/diabetes-medicine-thiazolidinediones/
  5. glucagon: https://dsm.diabetesselfmanagement.com/diabetes-resources/definitions/glucagon/
  6. type 2 diabetes: https://dsm.diabetesselfmanagement.com/diabetes-resources/definitions/type-2-diabetes/
  7. insulin: https://dsm.diabetesselfmanagement.com/blog/what-does-insulin-do/
  8. urinary tract infections: https://dsm.diabetesselfmanagement.com/blog/what-you-need-to-know-about-utis/
  9. hypoglycemia: https://dsm.diabetesselfmanagement.com/diabetes-resources/definitions/hypoglycemia/
  10. metformin: https://dsm.diabetesselfmanagement.com/blog/diabetes-medicine-metformin/
  11. sulfonylureas: https://dsm.diabetesselfmanagement.com/blog/diabetes-medicine-sulfonylureas/
  12. meglitinides: https://dsm.diabetesselfmanagement.com/blog/diabetes-medicine-meglitinides/
  13. thiazolidinediones: https://dsm.diabetesselfmanagement.com/blog/diabetes-medicine-thiazolidinediones/
  14. SGLT2 inhibitors: https://dsm.diabetesselfmanagement.com/blog/diabetes-medicine-sglt2-inhibitors/
  15. alpha-glucosidase inhibitors: https://dsm.diabetesselfmanagement.com/blog/diabetes-medicine-alpha-glucosidase-inhibitors/
  16. bile acid sequestrants and dopamine receptor agonists: https://dsm.diabetesselfmanagement.com/blog/diabetes-medicine-bile-acid-sequestrants-and-dopamine-receptor-agonists/
  17. non-insulin injectable diabetes medications: https://dsm.diabetesselfmanagement.com/blog/non-insulin-injectable-diabetes-medications/
  18. insulin: https://dsm.diabetesselfmanagement.com/blog/insulin-what-you-need-to-know/

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Amy Campbell: Amy Campbell is the author of Staying Healthy with Diabetes: Nutrition and Meal Planning and a frequent contributor to Diabetes Self-Management and Diabetes & You. She has co-authored several books, including the The Joslin Guide to Diabetes and the American Diabetes Association’s 16 Myths of a “Diabetic Diet,” for which she received a Will Solimene Award of Excellence in Medical Communication and a National Health Information Award in 2000. Amy also developed menus for Fit Not Fat at Forty Plus and co-authored Eat Carbs, Lose Weight with fitness expert Denise Austin. Amy earned a bachelor’s degree in nutrition from Simmons College and a master’s degree in nutrition education from Boston University. In addition to being a Registered Dietitian, she is a Certified Diabetes Educator and a member of the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators. Amy was formerly a Diabetes and Nutrition Educator at Joslin Diabetes Center, where she was responsible for the development, implementation, and evaluation of disease management programs, including clinical guideline and educational material development, and the development, testing, and implementation of disease management applications. She is currently the Director of Clinical Education Content Development and Training at Good Measures. Amy has developed and conducted training sessions for various disease and case management programs and is a frequent presenter at disease management events.

Disclaimer of Medical Advice: Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information, which comes from qualified medical writers, does not constitute medical advice or recommendation of any kind, and you should not rely on any information contained in such posts or comments to replace consultations with your qualified health care professionals to meet your individual needs.