Susan Cornell
In this article, recommendations from the 2012 American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) position statement are discussed with an emphasis on the appropriate use of Dipeptidyl Peptidase-4 (DPP-4) inhibitors in individuals with Type 2 Diabetes Mellitus (T2DM). The 2012 ADA/EASD position statement emphasizes individualization of treatment, with glycated hemoglobin (A1C) targets being determined for each patient based on life expectancy, complications, disease duration, comorbidities, such as cardiovascular disease or cognitive impairment, and the risk of hypoglycemia and other adverse events. Patients’ attitudes and support systems should also be considered. Recommendations for pharmacotherapy are less prescriptive and should be based on a patient’s needs, preferences, and tolerances. In general, metformin is recommended as firstline therapy for most patients, although combination of 2 noninsulin agents or insulin alone should be considered in patients with baseline A1C ≥ 9.0%. Add-on therapy to metformin will likely be needed to achieve and maintain glycemic control as the disease progresses. It is important to avoid therapies that increase the risk of weight gain or and, especially in older patients, hypoglycemia. As discussed in this review, DPP-4 inhibitors are well tolerated and effectively lower A1C and improve β-cell function without increasing the risk of hypoglycemia and weight gain. DPP- 4 inhibitors are recommended as an option for first-line therapy when metformin is contraindicated or not tolerated and are also recommended as an option for add-on therapy to metformin and to metformin plus a sulfonylurea, a thiazolidinedione, or insulin. This article reviews the appropriate use of DPP-4 inhibitors in individuals with T2DM and recently published cardiovascular outcome trials with DPP-4 inhibitors.