GLP-1 & Incretin

Dipeptidyl peptidase-4 (DPP-4) inhibitors

(e.g. Vildagliptin, sitagliptin, linagliptin, alogliptin, saxagliptin)

• natural hormones which prevent metabolism of incretins, GIP and GLP
• increase insulin release (& block glucagon) and slow stomach emptying
• oral preparation
• trials to date show that the drugs are relatively well tolerated with no increased incidence of hypoglycaemia
• do NOT cause weight gain

Adverse effects: mild UTI/URIs, vulvovaginal candidiasis

NICE guidelines on DPP-4 inhibitors

• continue DPP-4 inhibitor only if there is a reduction of > 0.5 percentage points in HBA1c in 6 months
• NICE suggest that a DPP-4 inhibitor might be preferable to a thiazolidinedione if further weight gain would cause significant problems, a thiazolidinedione is contraindicated or the person has had a poor response to a thiazolidinedione