Potential role of oral DPP-4 inhibitors in the ADA/EASD consensus statement algorithm for achieving and maintaining tight glycaemic control in type 2 diabetes: recommendations for oral antidiabetic agents

Abstract

A recently published American Diabetes Association/European Association for the Study of Diabetes consensus statement on the management of hyperglycaemia in type 2 diabetes emphasises the achievement and maintenance of normal glycaemic control and the rapid addition of medications and transition to new regimens when glycaemic goals are not achieved or sustained. An algorithm for the use of available interventions is supplied to help practitioners avoid prolonged periods of inadequate glycaemic control. Recommendations include rapid transition to combination treatment with oral agents and with insulin plus oral agents. The currently available oral agents are reviewed here with respect to the consensus statement recommendations, and the characteristics of the new class of oral dipeptidyl peptidase-4 inhibitors are summarised. These agents offer clinically meaningful reductions in HbA1c without significant risk of hypoglycaemia and without causing weight gain; they also offer the theoretical potential of improving or maintaining beta-cell function and thus, favourably affecting the progressive loss of function that is characteristic of type 2 diabetes. Potential uses of these agents in the context of the consensus statement recommendations are considered.