184.108.40.206 Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors)
- Prescribe as per NICE NG28 See also NICE visual summary for blood glucose lowering therapy in adults with type 2 diabetes.
- DPP-4 inhibitors have been shown to have a modest impact on HbA1c with mean reduction of 0.6-0.8%, but there is no data on morbidity, mortality or long-term adverse effects. Review after 6 months to assess benefit.
- The DPP-4 inhibitors differ in terms of their licensed indications / combinations.
- Sitagliptin has the greatest clinical experience and widest range of licensed indications and has demonstrated cardiovascular safety in outcome trials.
- A small increased risk of acute pancreatitis has been identified for all licensed DPP-4 inhibitors. Patients should be informed of the characteristic symptoms of acute pancreatitis – persistent, severe abdominal pain (sometimes radiating to the back) – and encouraged to tell their healthcare provider if they have such symptoms. Refer to MHRA for full details.