AUTHOR:-DR  PREMANIDHI PANDA,
       M.D(MED),HON PhD IN DIABETES(USA),MRCP,FRCP
       DIRECTOR,Prof. Panda DIABETES INSTITUTE( INDIA)    
Abstract:-
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:-

• sitagliptin (Januvia)
• vildagliptin (Galvus)
• saxagliptin (Onglyza)
• linagliptin (Trajenta)
• alogliptin (Nesina)
• Alogliptin.
• Teneligliptin

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 lower blood glucose levels at the recommended doses.
• All three gliptins appear to be equally effective.
• When taken together with metformin, gliptins don’t seem to increase the chances of hypoglycaemia or weight gain.
• They are an oral medicine and so are an alternative for people who cannot take a combination of metformin and a sulfonylurea.

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:-

• Hypoglycaemia and weight gain when used with a sulfonylurea, but not with metformin.
• dizziness, headaches and cold-like symptoms
• infections of the respiratory and urinary tract.
• Allergic Reaction  like swelling of  mouth,Face,Tongue & Throat etc.
• Bone Fracture  in Saxagliptin.
• Pancreatitis  Although rare.But have to kept in mind.
• Lastly  Gliptin should be  prescribed cautiously. Not frequently.

 

WHO CAN TAKE GLIPTIN:-
People with type 2 diabetes whose:

• blood glucose is inadequately controlled by metformin, a sulfonylurea or a glitazone alone
• levels of glycated haemoglobin (HbA1c) is higher than 53mmol/mol (>7%) who are not likely to respond to a single medicine alone may be prescribed saxagliptin (Onglyza) or linagliptin (Trajenta) together with metformin or a sulfonylurea.

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:

1. First line in T2DM with HbA1c <7%
2. Second line as add-on therapy in T2DM patients already on 1 out of the following {metfromin, SU, TZD, alfa-glucosidase inhibitor, miglitinide})for uncontrolled T2DM with HbA1c >7%
3. Third line as add-on therapy in T2DM patients already on combination therapy (2 out of the following {metfromin, SU, TZD, alfa-glucosidase inhibitor, miglitinide)

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.

Biography

DR PREMANIDHI PANDA,M.D(MED),HON PhD IN DIABETES,MRCP,FRCP has completed his M.B.B.S at the age of 24 years from Berhampur University, India and postdoctoral studies,M.D(MED) from UTKALUniversity School of Medicine. He is the director  of Prof. Panda DIABETES INSTITUTE,INDIA, a premier DIABETES  HOSPITAL CUM RESEARCH CENTRE,INDIA.He has worked in TISCO HOSPITAL,INDIA,BENGHAZI MEDICAL(LIBYA),MEDWIN HOSPITAL With Repute.He has been awarded as “INDIA’s BEST  DOCTOR AWARD:-2013(DIABETES)” BY MEDGATE TODAY SURVEY.He Has been Awarded MRCP,FRCP BY ROYAL COLLEGE OF PHYSICIAN AND SURGEON. He has published more than 20 papers in reputed journals and serving as Director of Prof. Panda DIABETES INSTITUTE,INDIA. He  has been awarded  several  National & International awards contribution in diabetes.