Sulphonylureas or dipeptidyl peptidase 4 inhibitors: which is the most suitable choice for patients with type 2 diabetes?

This review compared sulphonylureas and dipeptidyl peptidase 4 inhibitors for the treatment of type 2 diabetes.

Patients with type 2 diabetes (T2D) initially produce insulin (hormone which lowers blood sugar levels) but it fails to work in the body. There are many drugs available which can help insulin work in the body. Eventually, the pancreas fails to produce insulin. In this case, drugs which increase insulin release from the pancreas are needed.

Sulphonylureas (SU) are drugs which increase insulin release from the pancreas. Glipizide (Glucotrol) and Glimepiride (Glimer) are examples of SUs. Dipeptidyl peptidase 4 (DPP-4) inhibitors are glucose-lowering drugs that also increase insulin release. Sitagliptin (Januvia) is an example of a DPP-4 inhibitor. DPP-4 inhibitors are increasingly being used for the treatment of T2D.

This review aimed to summarize the advantages and disadvantages of SUs and DPP-4 inhibitors.

Control of blood glucose levels is similar with both SU and DPP-4 inhibitors. However, it is not known whether the long-term control of blood glucose levels differs between these drugs.

Side effects such as hypoglycemia (dangerously low blood glucose levels) and weight gain can occur in patients taking SU. DPP-4 inhibitors have fewer side effects and don’t normally cause hypoglycemia or weight gain. Therefore, DPP-4 inhibitors are preferred in patients who are at high risk of experiencing hypoglycamia, including elderly patients or those who have heart or kidney disease.

Published studies suggest that patients treated with SU have a higher risk of experiencing a cardiovascular event (stroke or heart attack). In contrast, studies have shown that DPP-4 inhibitors do not increase cardiovascular risk.

SU requires regular monitoring of blood glucose levels. Less frequent monitoring is sufficient in patients treated with a DPP-4 inhibitor.

DPP-4 inhibitors are more expensive than SUs, and the choice of drug prescribed may therefore be influenced by its cost.

This review concluded that the choice of prescribing a SU or DPP-4 inhibitor depends on the individual patient’s needs.

The authors have previously been employed by or involved with pharmaceutical companies who develop DPP-4 inhibitors.

Consult your physician regarding the risks and benefits of treatment with a DPP-4 inhibitor or sulphonylurea.