Abstract
Describing a reported case of acute pancreatitis in a patient receiving sitagliptin. We present the biochemical and findings of a 60 year-old male who presented with severe abdominal pain and was found to have acute pancreatitis. This occurred one month after the commencement of sitagliptin, a dipeptidyl peptidase IV inhibitor, for the treatment of uncontrolled type 2 diabetes. Results: Pancreatic enzymes were elevated (i.e. amylase 204, lipase: 525.3) with a normal liver function test and a normal lipid profile. Ultrasound abdomen was unremarkable. In the absence of an identifiable cause for the patient’s pancreatitis, sitagliptin was considered a potential trigger and on ceasing this agent, the patient recovered from his condition. Conclusion: Incretin-based therapy is an effective line in the treatment of type 2 diabetes mellitus. FDA issued a warning letters to the drug company because of emerging reports of acute pancreatitis in patients receiving sitagliptin. This is unfortunately not the first reported case of acute pancreatitis in a patient receiving sitagliptin and it supports the possibility that acute pancreatitis may be the effect of incretin-based therapy.
Highlights
Glucagon like peptide-1 (GLP-1) is an incretin hormone that results in glucose-dependent insulin secretion, suppression of glucagon secretion, a delay in gastric emptying, and a decrease in caloric intake likely seconddary to centrally mediated signaling [1]
The majority of known biological actions of GLP-1 depend on the presence of the two N-terminal amino acids; these are removed by the enzyme, dipeptidyl peptidase-4 (DPP-4), whose substrates are polypeptides with an alanine or a proline at the second position from the N-terminal side [2]
A. is a 60 years old Kuwaiti gentleman, with background history of Diabetes Mellitus for the past 10 years, no complications, he is on Insulin Glargine 30 U at bed time, Metformin 1gm trice daily, Repaglide 2 mg trice daily, and recently started on Sitagliptin 100 mg once daily (1 month ago)
Summary
Glucagon like peptide-1 (GLP-1) is an incretin hormone that results in glucose-dependent insulin secretion, suppression of glucagon secretion, a delay in gastric emptying, and a decrease in caloric intake likely seconddary to centrally mediated signaling [1]. DPP-4 inhibitors increase concentrations of active incretin hormones, GLP-1 and glucose-dependent insulinotropic polypeptide (secreted by the enteroendocrine L and K cells, respectively, which are substrates for DPP-4). This results in improved B-cell responsiveness to prevailing glucose concentrations and suppression of glucagon secretion [3]. Sitagliptin is an orally active, potent, and selective inhibitor of dipeptidyl peptidase IV (DPP-IV) for the treatment of type 2 diabetes. Several studies have demonstrated the efficacy and safety of sitagliptin in the management of type 2 diabetes, the safety of sitaglitin is questionable
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