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DPP-4 inhibitors are a type of medication that people with type 2 diabetes can use to lower blood sugar levels.

How do DPP-4 inhibitors work?

DPP-4 is an enzyme (a natural chemical) that breaks down hormone GLP-1. GLP-1 helps the body lower blood sugar levels by causing the pancreas to produce insulin after a meal. So, more GLP-1 means more insulin production and lower glucose levels. One way to increase levels of GLP-1 is by reducing levels of DPP-4. DPP-4 inhibitors lead to more GLP-1 that lasts longer in the bloodstream; this stimulates insulin production and decreases production of glucagon when glucose levels are high, lowering the body’s glucose levels.

Who uses DPP-4 inhibitors?

DPP-4 inhibitors are used by people with type 2 diabetes. This medication is generally not the first drug prescribed to lower glucose levels. Some people add DPP-4s onto existing metformin therapy or take DPP-4s alone or with other drugs.

What are the benefits?

  • DPP-4s have a low risk of hypoglycemia (low blood sugar) unless used together with sulfonylureas or insulin. Other drugs (such as sulfonylureas) have a higher risk of hypoglycemia, a major side effect of many glucose-lowering medications.

  • DPP-4 is an oral drug (a pill) so there’s no need for injections.

  • Studies show that DPP-4 is weight neutral and will not lead to an increase in weight. 

What are the drawbacks?

  • DPP-4s are not as effective as GLP-1 agonist medications. While DPP-4s have fewer side effects, they provide less glucose control, weight loss, and overall treatment satisfaction.

  • DPP-4s are more expensive than some other diabetes drugs like sulfonylureas and metformin.

Commonly used DPP-4 drugs:

  • Januvia (sitagliptin)

  • Onglyza (saxagliptin)

  • Tradjenta (linagliptin)

  • Nesina (alogliptin)

  • Galvus (vildagliptin) – not approved in US

More information:

Last updated: August 2, 2021