DPP-4 Inhibitors for Type 2 Diabetes



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Editors
Silvio Inzucchi, MD
Julio Rosenstock, MD



Additional Resources
Mayo Clinic
FDA

What are DPP-4 inhibitor medicines?

DPP-4 inhibitor medicines (generic names: sitagliptin saxagliptin, and linagliptin) are a type of incretin-based medicine for type 2 diabetes. This kind of medicine is based on the action of hormones called incretins, which help control how the pancreas works. GLP-1 incretins cause your pancreas to produce more insulin after you eat, helping your body use glucose. The effects of GLP-1 only last a few minutes, because an enzyme (a substance that causes a chemical reaction in your body) called DPP-4 quickly breaks down GLP-1 in the blood. DPP-4 inhibitors block the action of the DPP-4 enzyme. This makes GLP-1 last longer and increases the amount of GLP-1 in your blood. More GLP-1 means less glucose build-up in the blood.

DPP-4 inhibitors come in pill form and are taken by mouth. They are used alone or in combination with other diabetes medicines. They are also available in combination pills that contain a DPP-4 inhibitor and another type of diabetes medicine. Your dose of sitagliptin or saxagliptin (but not linagliptin) may need to be adjusted if you have kidney problems.

What are the benefits of DPP-4 inhibitors?

They help keep your blood glucose from going too high by increasing the insulin produced by your pancreas, especially right after you eat a meal and decreasing glucagon, a hormone that releases glucose from your liver.

What are the side effects and disadvantages of DPP-4 inhibitors?

DPP-4 inhibitors don’t cause low blood glucose, a condition called hypoglycemia. But you’re at risk for low blood glucose if you also take diabetes pills or insulin that can cause hypoglycemia. Low blood glucose can make you feel hungry, dizzy, nervous, shaky, or confused. You can learn what to eat or drink to bring your blood glucose level back up to normal.

DPP-4 inhibitors can cause a runny nose, sore throat, headache, or diarrhea. They may also cause inflammation of your pancreas, skin rash, hives, swelling of your face, or trouble breathing. Ask your doctor which signs to watch for and what to do if those signs happen.

How will I know which diabetes medicines are best for me?

Talk with your doctor about your diabetes medicines. Ask about whether there are other medicines that can help you. Tell your doctor about any side effects you have from your medicines. Be sure to tell your doctor about your other health conditions and whether you’re pregnant or planning to become pregnant. Then your doctor can make the best choice of medicine for you.

Questions to ask your doctor

  • What else can I do to keep my blood glucose levels under control?
  • How often should I have check-ups?
  • What side effects can happen with my medicines?
  • What should I do if I forget to take my diabetes medicine?
  • Should I see a diabetes educator?
  • Should I see an endocrinologist for my diabetes care?