AUTHOR:-DR PREMANIDHI PANDA,
M.D(MED),HON PhD IN DIABETES(USA),MRCP,FRCP
DIRECTOR,Prof. Panda DIABETES INSTITUTE( INDIA)
The oral DPP-4 inhibitors (GLIPTIN) are new incretin-based therapies for treatment of type 2 diabetes. The treatment of type 2 diabetes mellitus (T2DM) has included the use of metformin and sulfonylurea (SU) as first-line anti-diabetic therapies Throughout the world.Three Gliptin Saxegliptin,Sitagliptin & Vildagliptin has taken into study along with two other drugs like Metformin and glimiperide.In this other gliptins are linagliptin, alogliptin (Nesina),Tenegliptin not included these are newer gliptin.
In this 6months randomized trial, I have taken 1000 patient inadequately controlled with HbA1C 7to 10 patients with type 2 diabetes, who were treated by dual combination of metformin and glimiperide added on 5 mg saxagliptin group or 100 mg sitagliptin once daily group, or 50 mg vildagliptin twice daily for 6months randomised trial .FBS,2hr PPBS & HBA1C and hypoglycaemia and other adverse effect was evaluated.
After 6 months HBA1C Vildagliptin reduced to 1.4,Saxagliptin reduced to 1.2,Sitagliptin 1.1.FBS reduced to 40to 50mg/dl withvildagliptin,30 to 40mg/dl with saxagliptin,10 to 20mg with sitagliptin.2Hr PPBS with vildagliptin reduced to 60to 70mg/dl,with saxagliptin reduced to 40 to 50mg/dl,with sitagliptin 30-50mg/dl.No serious side effects seen in any of the medicine.
DISCUSSION:-‘Gliptins’ is the nickname given to a group of medicines called dipeptidyl peptidase-4 inhibitors. The gliptins given in are:-
The gliptins are effective at lowering blood glucose, but they have not been used for long enough to know whether they also reduce the long-term complications of diabetes (such as heart disease and stroke). This will only become clear when they have been used by more people for longer periods of time.
Secondly Gliptins are too much expensive difficult for poor.In India if anybody writes costly medicine Patients are thinking “VERY POWERFUL MEDICINE”
Particularly The gliptins are not taken on their own.It should be combined with sulfonylurea, Metformin & glitazone.I used to advice sulfonylurea and Metformin as First line of treatment.Then I used to add Pioglitazone.90%case used to control with this.In Indian set up the I used to add Voglibose Plus Metformin.If Not I add Gliptin Particularly Vildagliptin. The gliptins are one kind of diabetes medicine that can be used when SU and Metformin fails
HOW GLIPTINS WORKS AND ITS BENEFITS:-
Gliptins increase the amount of insulin in the blood when they are taken with metformin, sulfonylurea, or a glitazone. They also reduce the amount of glucose produced by the liver.
Gliptins are a new group of medicines, their long-term benefits are not fully known.
Long term effect of Diabetes not known such as Heart attack and Stroke.This can be prescribed after a long term when rule out any badly side effects.
SIDE EFFECTS OF GLIPTIN:-
WHO CAN TAKE GLIPTIN:-
People with type 2 diabetes whose:
You may not be able to take a gliptin if you have liver or kidney problems. Talk to your health professional as they may need to take this into account before deciding about prescribing a gliptin.
CONCLUSION:- Over 6months of trial it shows Vildagliptin is best among all and superior to saxagliptine and sitagliptine.Saxagliptin is superior to Sitagliptin.Mild hypoglycimia occure with all gliptin in few % of patient.Saxagliptin hypoglycaemia was more than vildagliptin.Other side effects are including diarrhea, headache, edema, abdominal discomfort, elevated liver enzymes, and chest discomfort or dyspnea.Lastly concluded that Along with metformin and glimiperide Vildagliptin and others are veryhelpful for good glycemic control.Out of all gliptin “VILDAGLIPTIN” is the best.
Current indications for use of gliptins are:
At the Last I will say Gliptins have revolutionized the concept of diabetes management and have provided a breath of fresh air to healthcare professionals dealing with diabetes.