DPP-4 inhibitors: A novel approach for management of type-2 diabetes mellitus

Abstract

Diabetes mellitus (DM) is one of the most common chronic disorders, with increasing prevalence worldwide. Type 2 diabetes (T2DM), a multifaceted disease involving multiple pathophysiological defects, accounts for nearly 85–95% of total reported cases of DM. Although being a primary objective in the management of type 2 diabetes, optimal glycemic control is difficult to achieve and usually not maintained over time. Type 2 diabetes is a complex pathology, comprising altered insulin sensitivity and impaired insulin secretion. The dipeptidyl peptidase (DPP-4) inhibitors are a new class of antihyperglycaemic agents which were developed for the treatment of type 2 diabetes. They differ in terms of their chemistry, they are all small molecules which are orally available. Several DPP-4 inhibitors (or gliptins) with different chemical structures are now available. These agents inhibit the degradation of the incretins glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) and hence potentiate glucose-dependent insulin secretion. They improve glycemic control, reducing both fasting and postprandial glucose levels to lower HbA1c levels, without weight gain and with an apparently benign adverse event profile. Hence DPP-4 inhibitors currently available have proven similar glucose lowering efficacy.