Abstract
The purpose of this review is to highlight the role of the incretin system and discuss the role of dipeptidyl peptidase (DPP)-4 inhibitors as potential treatment for diabetes, drawing attention to some of the available clinical trial data that support the use of such agents. The DPP-4 enzyme is involved in the breakdown of glucagon-like peptide (GLP)-1, an incretin that has a very short half-life. DPP-4 inhibitors delay the degradation of GLP-1, in turn extending the action of insulin and suppressing the release of glucagon. Endogenous and exogenous GLP-1 not only stimulates the release of insulin, but also reduces the secretion of glucagon. The latter action may be very important and represents a neglected aspect of the treatment of diabetes. The focus of the review is on one of the DPP-4 inhibitors, vildagliptin, since there is much recently published data on this drug. Vildagliptin has been shown to decrease hemoglobin A1C by 0.5–0.8% either alone or in combination. Generally, it is found to be well tolerated and safe, at least in the short term.
Financial disclosure
Diabetes research at Tulane University Health Sciences Center is supported in part by Susan Harling Robinson Fellowship in Diabetes Research and the Tullis-Tulane Alumni Chair in Diabetes.
Duality of Interest for Dr Vivian Fonseca: Research Support (to Tulane): Grants from GlaxoSmithKline, Novartis, Takeda, AstraZeneca, Pfizer, Sanofi-Aventis, Eli Lilly, NIH and ADA. Honoraria for Consulting and Lectures (to Tulane): GlaxoSmithKline, Novartis, Takeda, Pfizer, Sanofi-Aventis and Eli Lilly.