Impact of Dipeptidyl Peptidase-4 Inhibitors on Glycemic Control and Cardiovascular Safety with Adherence: An Overview

Diabetes is a ubiquitous chronic disease worldwide. The prevalence is expected to increase further to 9.9% by the year 2045. Dipeptidyl peptidase-4 (DPP-4) inhibitors, also called as gliptins, act as incretin enhancers. They inhibit glucagon secretion and arouse postprandial insulin secretion, both in a glucose-dependent mode. In 2006, sitagliptin was approved as a first DPP-4 inhibitor in the treatment of diabetes concurrently with lifestyle modification. Sitagliptin has a high bioavailability, while linagliptin has a safety and tolerability profile similar to that of placebo, with a very low risk for hypoglycemia. DPP-4 inhibitors have a weight neutrality effect. One major benefit of gliptins is their excellent tolerability/safety profile compared with other glucose-lowering medications, including other new glucose-lowering agents such as sodium/glucose cotransporter 2 inhibitors. Compared with sulfonylureas, they have a smaller decline in HbA1c. The three gliptins showed excellent effect on glycemic control as an add-on therapy in treating type 2 diabetes. The major adverse cardiovascular events, malignancy and pancreatitis, were not associated with the treatment with sitagliptin, a DPP-4 inhibitor. The objective of establishing cardiovascular safety trials such as SAVOR-TIMI 53, EXAMINE, TECOS, CAROLINA, and CARMELINA. DPP-4 inhibitors have higher rates of adherence and persistence compared with sulfonylureas and thiazolidinediones.