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DPP-4 Inhibitors

How they work: Inhibiting the enzyme DPP-4 increases the level of a hormone named GLP-1, which stimulates insulin production and decreases production of glucagon (insulin’s “opposite” hormone) when glucose levels are too high.

Who Uses Them: DPP-4 inhibitors are most often used by people with type 2 diabetes who have inadequate blood glucose control with just metformin alone. Some of these patients may choose to add a DPP-4 inhibitor onto their existing metformin therapy, although they can be taken alone or alongside drugs other than metformin.   

In-Depth Article: The DPP-4 Inhibitor Class – A quick description of the DPP-4 inhibitor class of drugs and a section comparing the most widely used drug in the category, Januvia, to other drug types.

Approved Drugs:

*Not approved in the United States

 

Pros

Cons

  • Low risk of hypoglycemia

  • Few side effects

  • Oral drug, no needles

  • Weight neutral

  • Potential for combination with other drugs

 

  • Not as effective as GLP-1 agonists

  • More expensive than sulfonylureas/metformin

  • Mild gastrointestinal side effects

  • Dose adjustment required in patients with impaired kidney function (except for Trajenta)

  • A few possible safety questions (pancreatitis, heart failure) are still being investigated