DPP-4 with metformin

Q: Dipeptidyl peptidase 4 (DPP-4) inhibitors should not be combined with metformin to avoid the risk of severe hypoglycemia.

A) True

B) False

Answer: B

DPP-4 inhibitors, the most popular one in the USA is sitagliptin (trade name Januvia), have a low risk of hypoglycemia even when used as an add-on therapy with metformin. The risk of hypoglycemia is higher when combined with insulin or sulfonylureas, which are well-known to cause hypoglycemia by themselves. 

This characteristic of a lower rate of hypoglycemia is particularly useful in patients with chronic renal disease, including patients who require dialysis.

Similarly, good or bad, they have minimal effect on body weight.

#endocrinology

References:

1.  Nauck MA, Meininger G, Sheng D, et al. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor, sitagliptin, compared with the sulfonylurea, glipizide, in patients with type 2 diabetes inadequately controlled on metformin alone: a randomized, double-blind, non-inferiority trial. Diabetes Obes Metab 2007; 9:194.

2. Gallwitz B, Rosenstock J, Rauch T, et al. 2-year efficacy and safety of linagliptin compared with glimepiride in patients with type 2 diabetes inadequately controlled on metformin: a randomised, double-blind, non-inferiority trial. Lancet 2012; 380:475.

3. Arjona Ferreira JC, Corry D, Mogensen CE, et al. Efficacy and safety of sitagliptin in patients with type 2 diabetes and ESRD receiving dialysis: a 54-week randomized trial. Am J Kidney Dis 2013; 61:579.