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Author Notes:

Fernando Gomez-Peralta, e-mail: fgomezperalta@gmail.com

The authors thank Marta Pulido, MD, PhD, for editing the manuscript and editorial assistance.

Fernando Gomez-Peralta has taken part in advisory panels for Sanofi and Novo Nordisk; has received research support from Sanofi, Novo Nordisk, Boehringer Ingelheim Pharmaceuticals and Lilly; and has acted as a speaker for Sanofi, Novo Nordisk, Boehringer Ingelheim Pharmaceuticals, AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Co. and Lilly.

Cristina Abreu has received research support from Sanofi, Novo Nordisk, Boehringer Ingelheim Pharmaceuticals and Lilly and has acted as a speaker for Sanofi, Novo Nordisk, Boehringer Ingelheim Pharmaceuticals, AstraZeneca Pharmaceuticals LP and Bristol-Myers Squibb Co.

Guillermo E. Umpierrez is partly supported by research grants from the Public Health Service (Grants UL1 TR002378 from the Clinical and Translational Science Award program and 1P30DK111024-01 from the National Institutes of Health and National Center for Research Resources). Guillermo E. Umpierrez has received unrestricted research support for inpatient studies (to Emory University) from Merck, Novo Nordisk, AstraZeneca, Boehringer Ingelheim, Insulcloud S.L. and Sanofi. Guillermo E. Umpierrez has received honoraria for being on the advisory board/a consultant from Sanofi, Intarcia and Jansen Pharmaceuticals.

Rafael J. Barranco has nothing to disclose.

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Research Funding:

No funding or sponsorship was received for this study or publication of this article.

Keywords:

  • Alogliptin
  • Basal insulin
  • DPP4 inhibitors
  • Glycemic control
  • Linagliptin
  • Saxagliptin
  • Sitagliptin
  • Type 2 diabetes
  • Vildagliptin

Safety and Efficacy of DPP4 Inhibitor and Basal Insulin in Type 2 Diabetes: An Updated Review and Challenging Clinical Scenarios

Tools:

Journal Title:

Diabetes Therapy

Volume:

Volume 9, Number 5

Publisher:

, Pages 1775-1789

Type of Work:

Article | Final Publisher PDF

Abstract:

The safety and efficacy of dipeptidyl peptidase-4 (DPP4) inhibitors as monotherapy or in combination with other oral antidiabetic agents or basal insulin are well established. DPP4 inhibitors stimulate glucose-dependent insulin secretion and inhibit glucagon production. As monotherapy, they reduce the hemoglobin A1c level by about 0.6–0.8%. The addition of a DPP4 inhibitor to basal insulin is an attractive option, because they lower both postprandial and fasting plasma glucose concentrations without increasing the risk of hypoglycemia or weight gain. The present review summarizes the extensive evidence on the combination therapy of DPP4 inhibitors and insulin-based regimens in patients with type 2 diabetes. We focus our discussion on challenging clinical scenarios including patients with chronic renal impairment, elderly persons and hospitalized patients. The evidence indicates that these drugs are highly effective and safe in the elderly and in the presence of mild, moderate and severe renal failure improving glycemic control with low risk of hypoglycemia. In addition, several randomized-controlled trials have shown that the use of DPP4 inhibitors in combination with basal insulin represents an alternative to the basal-bolus insulin regimen in hospitalized patients with type 2 diabetes.

Copyright information:

© 2018, The Author(s).

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/).

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