Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-26

Table 3. Dipeptidylpeptidase-4 (DPP-4) inhibitors (13,24,38,51,52,53,56,57,210) Dipeptidylpeptidase-4 (DPP-4) inhibitors Therapeutic Considerations Mechanism of action • Inhibits the DPP-4 enzyme that causes the rapid degradation of endogenous GLP-1. • Results in an enhanced and prolonged • Rare cases of pancreatitis • Rare cases of severe joint pain • URI, cough, headache

Cautions • Not recommended for use in type 1 diabetes, pregnancy, breast-feeding or children <18 years of age. • History of pancreatitis or pancreatic cancer

action of endogenous GLP-1 and GIP, thereby increasing glucose-mediated insulin secretion (39). Benefits • A1C 0.5–0.7% • Targets postprandial BG control (9) • Weight neutral • Does not cause hypoglycemia Sitagliptin (Januvia®) • TDD: 100 mg • Frequency: QD • Administration: Taken with or without food. Dosing schedule • Initiate at 100 mg daily (or renally appropriate dose) • Does not require a dosage adjustment for people with eGFR > 45 mL/min/1.73m 2 , mild hepatic impairment or in the elderly. • Available: 25 mg, 50 mg, 100 mg

Caution • Not recommended for use in NYHA Class III-IV CHF, and severe hepatic impairment. • Assess renal function prior to initiation and periodically thereafter. Dosage adjustment is recommended in moderate or severe renal impairment. • eGFR 30-49 mL/min/1.73m 2 = 50 mg • eGFR <30 mL/min/1.73m 2 = 25 mg Monitoring • Assess renal function prior to initiation and periodically thereafter. Caution • Not recommended for use in NYHA Class III-IV CHF, moderate to severe hepatic impairment. • risk of heart failure Dosage adjustment is recommended in moderate or severe renal impairment. • eGFR ≥1 5 to <50 mL/min/1.73m 2 = 2.5 mg • Not recommended if eGFR <15 mL/min/1.73m 2 .

Saxagliptin (Onglyza®) • TDD: 2.5 mg - 5 mg • Frequency: QD •

Administration: Taken in the morning, with or without food.