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The researchers reviewed 601 published trials of older people to investigate whether the efficacy of three medications — DPP-4 inhibitors, SGLT2 inhibitors, and GLP-1 agonists — was affected ...
DPP-4 inhibitors and GLP-1. Inhibitors of dipeptidyl peptidase 4 (DPP-4 inhibitors or gliptins) are a class of oral hypoglycemics that block the enzyme dipeptidyl peptidase-4 (DPP-4). They can be used to treat diabetes mellitus type 2. The first agent of the class – sitagliptin – was approved by the FDA in 2006. [1]
Aromatic heterocyclic-based DPP-4 inhibitors have gained increased attention recently. The first patents describing xanthines (Figure 10) as DPP-4 inhibitors came from Boehringer-Ingelheim(BI) and Novo Nordisk. [21] When xanthine based DPP-4 inhibitors are compared with sitagliptin and vildagliptin it has shown a superior profile.
Medications based on incretins are used in the treatment of type 2 diabetes mellitus as well as the management of obesity.. Most of the earliest incretin-targeting agents to be approved fell into the class of DPP-4 inhibitors; these inhibit DPP-4 and thus prevent the enzymatic degradation of GLP-1 and GIP.
In one review of 14 studies, researchers found GLP-1 agonists led to an average weight loss difference of 4-6.2 percent in people with diabetes versus 6.1-17.4 percent in people without diabetes ...
Vildagliptin inhibits the inactivation of GLP-1 [2] [3] and GIP [3] by DPP-4, allowing GLP-1 and GIP to potentiate the secretion of insulin in the beta cells and suppress glucagon release by the alpha cells of the islets of Langerhans in the pancreas. It was approved by the EMA in 2007. [4]
Another class of anti-diabetes drugs, DPP-4 inhibitors, work by reducing the breakdown of endogenous GLP-1, and are generally considered less potent than GLP-1 agonists. [3] Some of the metabolic effects of GLP-1 agonists in rodents are mediated via increased synthesis of fibroblast growth factor 21 ( FGF21 ).
GLP-1 analogs resulted in weight loss and had more gastrointestinal side-effects, while in general dipeptidyl peptidase-4 (DPP-4) inhibitors were weight-neutral and are associated with increased risk for infection and headache. Both classes appear to present an alternative to other antidiabetic drugs.
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