Gliptins are a class of oral prescription medications used to manage Type 2 diabetes. These drugs are also known as dipeptidyl peptidase-4 (DPP-4) inhibitors. This medication class is a treatment option for adults, often used when diet and exercise alone are insufficient to achieve blood sugar control.
How Gliptins Regulate Blood Sugar
The human body possesses a natural system involving hormones called incretins, which play a role in regulating blood glucose levels after eating. After a meal, the gut releases these incretin hormones, such as glucagon-like peptide-1 (GLP-1). These hormones then signal the pancreas to increase insulin secretion, particularly when blood glucose concentrations are elevated. Concurrently, incretins also help reduce the amount of sugar the liver produces by suppressing glucagon release.
However, the body also produces an enzyme called dipeptidyl peptidase-4 (DPP-4), which quickly breaks down and deactivates these beneficial incretin hormones. Gliptins work by blocking this DPP-4 enzyme. By preventing DPP-4 from breaking down incretins, gliptins allow the body’s own GLP-1 and other incretin hormones to remain active for a longer period. This extended action enhances the natural processes that lower blood sugar levels, especially after meals.
Common Gliptin Medications
Several gliptin medications are commonly prescribed for the management of Type 2 diabetes. One widely recognized gliptin is sitagliptin, often known by its brand name Januvia. Another frequently used medication in this class is saxagliptin, marketed as Onglyza.
Linagliptin (Tradjenta) and alogliptin (Nesina) are also common gliptins. These medications are typically taken once daily as oral tablets. Some gliptins are also available in combination pills, often formulated with other diabetes medications such as metformin, to offer a more comprehensive approach to blood sugar control.
Potential Side Effects
While generally well-tolerated, gliptins can cause side effects. Common reactions include headaches, upper respiratory tract infections (such as a stuffy nose or sore throat), and urinary tract infections.
Patients should be aware of less frequent but more serious potential side effects. These include pancreatitis (an inflammation of the pancreas) and severe joint pain (arthralgia).
Specific gliptins, namely saxagliptin and alogliptin, have been associated with an increased risk of hospitalization for heart failure. This risk is relevant for patients with pre-existing heart or kidney disease. Patients should always discuss their complete medical history, including any heart or kidney conditions, with their doctor to determine the most appropriate treatment.
Use in Diabetes Treatment Plans
Gliptins are not the initial medication prescribed for Type 2 diabetes. Metformin is the first-line treatment choice. Gliptins serve as a second-line or third-line agent in diabetes management, often added when metformin alone is insufficient to achieve target blood sugar levels.
Gliptins are also a suitable option for patients who experience intolerance to metformin. An advantage of gliptins is their low risk of causing hypoglycemia, especially when used as monotherapy. These medications are weight-neutral, meaning they do not lead to weight gain or loss.