Comparison of Trelagliptin vs. other dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes mellitus: A 24-week real-world prospective comparative study

Objectives Type 2 diabetes mellitus (T2DM), a global epidemic, requires sustained glycemic control to prevent acute and chronic complications. Because of their weight neutrality and safety, dipeptidyl peptidase-4 (DPP-4) inhibitors are frequently used; however, daily dosage may restrict adherence. One possible remedy is Trelagliptin, a once-weekly DPP-4 inhibitor that increases compliance without sacrificing effectiveness. Material and Methods During the course of 24 weeks (April-September 2025), 117 patients with well-controlled or nearly controlled T2D who were already taking DPP-4 inhibitors participated in this real-world, prospective, interventional, comparative study at a tertiary teaching hospital in North India. Once-weekly Trelagliptin was administered to eligible participants who were taking stable doses of vildagliptin, sitagliptin, linagliptin, or teneligliptin. Fasting plasma glucose (FPG), postprandial glucose (PPG), and HbA1c levels were measured at baseline and at follow-up. The student’s t-test was used for statistical analysis, and a p <0.05 was deemed significant. Results The mean age of each group was 43.1 ± 5.7 years, and their BMI was 24.1 ± 3.1 kg/m 2 . Trelagliptin and other DPP-4 inhibitors did not significantly differ in HbA1c values at baseline, 12 weeks, or 24 weeks ( p >0.38). Trelagliptin caused a mean HbA1c reduction from baseline of -0.08%, while daily DPP-4 inhibitors caused a reduction of -0.09%, suggesting non-inferiority. PPG stayed similar ( p >0.65), and a slight increase in FPG with Trelagliptin ( p = 0.03–0.04 vs vildagliptin/sitagliptin) was not clinically significant. There were no reports of hypoglycemia or adverse events. Conclusion Trelagliptin showed comparable safety and non-inferior efficacy to daily gliptins, with the added benefit of weekly dosing for greater convenience. It is an affordable, adherence-boosting solution for long-term glycemic control in T2D.