Patients with type 2 diabetes frequently require multiple oral medications to help lower their blood sugar. New medications are becoming available which makes it more difficult to determine when is the best time to use them. DPP-4 (dipeptidyl peptidase-4) inibitors like sitagliptin (Januvia) and saxagliptin (Onglyza) are now part of the diabetes armamentarium.
How DPP-4 Inhibitors Work
According to the American Association of Clinical Endocrinololgists (AACE), these "gliptin" medications work in the gut to help patients process glucose after a meal. Gliptins block dipeptidyl peptidase, an enzyme that breaks down incretin hormones. These incretins help to increase insulin production after a meal and decrease the amount of glucose made by the liver. By blocking the enzyme that destroys incretin hormones, the gliptins give these hormones more time to work, which lowers blood glucose levels.
Using Gliptins for Diabetes
According to the prescribing information for Januvia and Onglyza, both currently available gliptins are oral medications and can be taken once daily. They can be used alone or in combination with other oral medicines to lower blood sugar. This class of medications is not appropriate for use in patients with type 1 diabetes who require insulin to manage their blood sugar. These medications generally do not cause weight gain in patients with diabetes.
Patients with kidney problems will need lower doses of gliptins to manage blood sugar. Low blood sugar is not typically a problem with gliptins when they are used alone, but can occur in combination with other diabetes medications that cause low blood sugar. Health care providers should be aware of the risk of pancreatitis with Januvia.
Because they are new, the gliptin medications are a costly option for diabetes treatment. Drugstore.com lists a one month supply of Januvia 100 mg tablets at just over $200. Onglyza has a similar price for a one month supply. This is the cash price and may vary depending on a patient's insurance coverage. These medications are not currently available in generic forms. Older diabetes medications like metformin are available as a generic and are much more affordable.
Patients with diabetes who are interested in gliptins should talk to their health care provider to determine if these medications are an appropriate option for them.
References:
AACE/ACE Glycemic Control Algorithm Consensus Panel. Endocrine Practice. 2009;15:541.
Januvia Prescribing Information. Merck & Co, Inc. 2010. Accessed June 28, 2010.
Onglyza Prescribing Information. Bristol-Myers Squibb. 2009. Accessed June 28, 2010.
Drug Prices and Information. Drugstore.com. Accessed June 28, 2010.
Melissa Murfin - Melissa is a physician assistant in endocrinology with a further specialization in thyroid and parathyroid disorders. She is also a ...
