diabetes mellitus
Research
Treatment
Source: Diabetes, Obesity and Metabolism
Sulphonylureas or dipeptidyl peptidase 4 inhibitors: which is the most suitable choice for patients with type 2 diabetes?
In a nutshell
This review compared sulphonylureas and dipeptidyl peptidase 4 inhibitors for the treatment of type 2 diabetes.
Some background
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.
Methods & findings
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.
The bottom line
This review concluded that the choice of prescribing a SU or DPP-4 inhibitor depends on the individual patient’s needs.
The fine print
The authors have previously been employed by or involved with pharmaceutical companies who develop DPP-4 inhibitors.
What's next?
Consult your physician regarding the risks and benefits of treatment with a DPP-4 inhibitor or sulphonylurea.
Disclaimer:
This information should not be relied upon as a substitute for personal medical advice, diagnosis or treatment. Use the information provided by Medivizor solely at your own risk. Medivizor makes no warranties or representations as to the accuracy of information provided herein. If you have any concerns about your health, please consult a physician.
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Thank for this article. I wish you mention how many times a day we should take it. Reply
Hi Jamal, how often a drug is taken will depend on the specific type, the dose, and the patient need. Many of these are taken once a day, but that can vary. Thanks for your question! Reply
Sounds very interesting, I have been on Metformin 4 X 500mg for 7 years and I don't seem to get my Hba1c down under 7, my last was 57. Reply
This is a message for Peter. I suggest you see your GP with the above review. You have been on maximum dose of Metformin for 7 years. I do think you need another medication added to what you are currently taking for your treatment to be more effective but it will depend on your age, weight, liver function test to decide which treatment is more appropriate. Good luck. Reply
I am going to see my diabetic nurse next week. I am currently 182cm tall and 91kgs, my liver function is good and I have no CV problems. I am currently on Sukkarto SR 4 x 500mg, Gliclazide 4 x 80 mg, Nateglinide 4 x 60mg, Vitamin B strong compound x 2 daily, 2Mg Diazepam at night, Quinine Sulphate 1x 200mg at night, 1 x 50mg Amitryptiline at night, 1 x 20mg furosemide in a.m. and 4 x 100mg of Tramadol, 2 in a.m. and 2 at night. I suffer from DPN with burning effect not loss of sensation and intermittent claudication in lower legs due to narrowing of arteries in feet and I smoke about 12.5 grams tobacco per day. I eat a fair amount of carbs due to a low income although I try to balance diet. I am going to see if I can swap the metformin ( Sukkarto ) for sitagliptin to see if that is any better. Reply
I too was on Metformin , 1000 x2 times per day, which was controlling me for many years, and then i suddenly developed slight liver problems and AIC went overboard, i was taken off Metformin placed on Glipizide, and that was not helping by itself, i am back on 500mg metformin, 100mg 1x perday Invokana, and 2.5 mgER glipixide, and that combination has been helping me to get to 6.9. But with Glipizide in picture, I am gaining weight. My goal is to get off some of the Meds, and hopefully Glipizide will be the first, because of weight issues with it.
Ann Reply
Je prend 5 injection par jours 1 avant chaque repas de 9 a 11 rapide une de 85 l'antus séparé en deux et une de Victoria en plus de4 metformine Reply
I am currently 68. The specialist clinic seem to be okay with this but I would like to be lower. I have been on egregious per day of metformin and 6mg of glimepiride for years. I now also take 10 units twice a day of humulin as well. I am having difficulty keeping weight down as a result of this. My clinic does not seem to want to change my regime.
Reply
I was suggested a low dose once a day of glimepirude 2 followed by DPP4(vidagliptin) twice of 50 mg with 850 metformin after breakfast and dinner. He said the regimen is more effective. Is it correct ? Reply