Intended for healthcare professionals


The role of dipeptidyl peptidase-4 inhibitors

BMJ 2012; 344 doi: (Published 12 March 2012) Cite this as: BMJ 2012;344:e1213
  1. Daniel Lasserson, senior clinical researcher1,
  2. Jonathan Mant, professor of primary care research2
  1. 1Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2ET, UK
  2. 2Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
  1. daniel.lasserson{at}

Will be clearer once ongoing trials are complete

Type 2 diabetes is a progressive disease and greater treatment intensity is needed over time to control increasingly abnormal glucose concentrations.1 In the linked article (doi:10.1136/bmj.e1369), Karagiannis and colleagues present a systematic review and meta-analysis of the risks and benefits associated with one of the relatively new classes of oral hypoglycaemic drugs, the dipeptidyl peptidase-4 (DPP-4) inhibitors.2

DPP-4 inhibitors reduce the breakdown of the glucose responsive incretin hormones, mainly glucagon-like peptide 1 (GLP-1); they have multiple physiological effects that together normalise glucose homeostasis without increasing body weight.3 Because GLP-1 is released in response to raised rather than normal glucose concentrations, DPP-4 inhibitors may be less likely to cause hypoglycaemia than other oral hypoglycaemic agents.3 Increased GLP-1 activity is associated with favourable changes in cardiovascular risk parameters of weight, lipids, blood pressure, and ventricular function, but no trials of DPP-4 inhibitors that are powered to detect differences in cardiovascular events have been reported.4

Karagiannis and colleagues examined two potential roles of DPP-4 inhibitors in type 2 diabetes: as monotherapy (compared with metformin) and …

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