Dipeptidyl peptidase 4 inhibitors in modern domestic practice

Abstract

The choice of treatment of diabetes mellitus type 2 is personalized, based on modern Russian and international algorithms for management of such patients. Given the initial level of decompensation of the disease at the time of diagnosis (at the level of glycated hemoglobin), most patients with type 2 diabetes at the time of initiation of therapy requires the combined treatment, at least two antidiabetic drugs. In modern conditions, on the basis of evidence-based medicine, priority should be given to drugs with a low risk of hypoglycemic conditions and do not affect or reduce body weight. In this article we consider a class of inhibitors of dipeptidyl peptidase 4, which entered into clinical practice since 2006 for the treatment of patients suffering from diabetes mellitus type 2, with an emphasis on drugs used in the Russian Federation. Today in our country there are seven members of the class of inhibitors of dipeptidyl peptidase 4. The results of the major randomized clinical trials (SAVOR-TIMI 53, EXAMINE, TECOS, CAROLINA), which studied the cardiovascular safety of dipeptidyl peptidase 4 inhibitors, showed the intra class heterogeneity with respect to data on the frequency of hospitalizations due to chronic heart failure. Have proven cardiovascular neutrality in relation to the primary combined cardiovascular outcome was MACE, including cardiovascular death, nonfatal myocardial infarction and nonfatal stroke. A major problem is the choice of effective glucose-lowering therapy to special patient groups. Assign their profession the safety of drugs plays a key role. With its high efficiency and unique glucosidation mechanism of action, guaranteeing a low risk of hypoglycemia and high safety, the drugs of this group has firmly taken its niche among the priority hypoglycemic drugs.