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Clinical use of dipeptidyl peptidase-4 and sodium-glucose cotransporter 2 inhibitors in combination therapy for type 2 diabetes mellitus.
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In the clamp-assessed study, insulin sensitivity improved by about 15% after six weeks of vildagliptin therapy in a combined cohort of drug-naïve and metformin-treated type 2 diabetic patients.
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Vild agliptin works by increasing the amount of two incretin hormones found in the body, called glucagon-like peptide-1 (GLP-1) and glucose- dependent insulinotrop ic peptide (GIP).
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Comparative effectiveness of sulfonylurea and metformin monotherapy on cardiovascular events in type 2 diabetes mellitus: a cohort study.
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Hermansen K, Kipnes M, Luo E, Fanurik D, Khatami H, Stein P 2007 Efficacy and safety of the dipeptidyl peptidase-4 inhibitor, sitagliptin, in patients with type 2 diabetes mellitus inadequately controlled on glimepiride alone or on glimepiride and metformin.
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The risk of hypoglycaemia related to the addition of a DPP-4 inhibitor to sulphonylurea is acknowledged in the summaries of product characteristics for DPP-4 inhibitors; most recommend using full dose DPP-4 inhibitors but a reduced sulphonylurea dose in patients taking such combinations, although the magnitude of reduction is not stated.
However, patients with mild T2DM on low-dose vildagliptin showed a return of HbA 1c to pretreatment levels after 108 wk.
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Kolterman OG, Buse JB, Fineman MS, Gaines E, Heintz S, Bicsak TA, Taylor K, Kim D, Aisporna M, Wang Y, Baron AD 2003 Synthetic exendin-4 (exenatide) significantly reduces postprandial and fasting plasma glucose in subjects with type 2 diabetes.
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The equi-effective doses in the setting of combination usage with metformin are vildagliptin 50 mg twice daily, sitagliptin 100 mg daily, pioglitazone 30 mg daily, and rosiglitazone 8 mg daily.
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