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T2D Medicine DPP-4 Inhibitor (Januvia)

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T2D Medicine DPP-4 Inhibitor (Januvia)

Januvia (DPP-4 inhibitor) lowers blood-glucose by helping body to make more insulin when needed. In addition, it stops the liver from putting glucose into the blood.

DPP-4 inhibitor or gliptin works by increasing the amount of insulin released by your body and decreasing the amount of sugar made by your body.  Dipeptidyl-peptidase 4 inhibitors preferentially target post-prandial glucose excursions; however, it also shows to decrease fasting plasma glucose levels.

Dipeptidyl-Peptidase 4 Inhibitors mechanism of action

DPP-4 inhibitors work by increasing incretin levels (GLP-1 and GIP) this inhibits glucagon release, which increases insulin secretion, delay gastric emptying, and decreases blood-glucose levels.

Dipeptidyl-Peptidase 4 Inhibitors diabetes medications

  • Generic Name: Linagliptin (Brand Name: Tradjenta)
  • Generic Name: Saxagliptin (Brand Name: Onglyza)
  • Generic Name: Sitagliptin (Brand Name: Januvia)
  • Generic Name: Alogliptin (Brand Name: Nesina)

DPP-4 inhibitor’s dosage

The recommended dose is 5 mg once daily, can be taken with or without food.

Side effects of DPP-4 inhibitors

Long-term effects of DPP-4 inhibitors on mortality and morbidity are so far inconclusive, although adverse effects, including nasopharyngitis (the common cold), headache, nausea, hypersensitivity and skin reactions, have observed in clinical studies.

What you can expect for DPP-4 inhibitors?

DPP-4 inhibitors can lower your A1C by 0.5 to 1.0%, fasting-plasma glucose level by 11 to 22 mg/dL or 0.611 to 1.222 mmol/l, postprandial glucose level by 24 to 35 mg/dL or 1.333 to 1.944 mmol/l. There is no change in lipid, no hypoglycemia, no weight gain. A greater reduction in blood-glucose levels is with a higher baseline A1C level (i.e., A1C ≥ 9.0%); while a history of previous, glucose-lowering treatment generally results in a smaller reduction in blood-glucose levels.

Who can benefit from DPP-4 inhibitors?

While they do not lower glucose largely than existing therapies, they offer many potential advantages.  It has an ability to achieve sustainable reductions in HbA1c with a low risk of hypoglycemia and no weight gain. It can administer as a once-daily oral dose.

Who should avoid using DPP-4 inhibitors?

Avoid Januvia, if you are pregnant or breast-feeding, having kidney disease, or type 1 with diabetic ketoacidosis.

DPP4 inhibitor is safer than sulfonylurea when comparing the incidence of hypoglycemia. However, in combination with other drugs, it has a somewhat higher rate of hypoglycemia. DPP-4 has an association with the immune system; it thought to inhibit it and might impair the immune system. Thus, increase the risk of upper respiratory infection (6.3%) and nasopharyngitis (inflammation of the nose and pharynx in 5.2%).

Primarily, the kidneys break it down and in a small extent by the liver; so the potential for it to interact with other drugs is relatively low.  Thus, DPP-4 inhibitors (only in reduced doses) are safe for treating patients with moderate and severe renal failure. The most worrying side effects are allergic reaction causing anaphylaxis, a body wide reaction resulting in low blood pressure, and angioedema, swelling of the tongue, face, and throat.

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