Q: 54 years old obese male with a long-standing type 2 Diabetes Mellitus (DM-2) is admitted to ICU with acute abdominal pain as well as shortness of breath associated with pedal edema. A few weeks ago, Sitagliptin was added to the drug regimen of his diabetic management. What are the few differential diagnoses?
Answer: Dipeptidyl peptidase 4 (DPP-4) is getting popular in outpatient clinics for the management of DM-2. DPP-4 is a Glucagon-like peptide 1 (GLP-1)-based therapy. It is an effective medicine as it works through various mechanisms which are attractive to clinicians including an increase glucose-dependent insulin secretion, decrease gastric emptying (decrease food intake - weight loss), and reduce postprandial glucagon. Another attractive feature is the rare occurrence of hypoglycemia with its use.
Said that it is still not considered the first line of therapy in DM-2.
The drugs included in this class are Sitagliptin, Saxagliptin, Linagliptin, and Alogliptin. There are few side effects which in-patients physicians need to be aware of:- Exacerbation of congestive heart failure (CHF)
- Nasopharyngitis
- Acute pancreatitis
- Hepatitis
- Inflammatory bowel disease
- Severe skin reactions
- Severe joint pain
- Myalgias and muscle spasms
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