Disclosures Advisory Board for Boehringer Ingelheim, Eli Lilly & Co., Novo Nordisk, Janssen, and Abbott Diabetes Care; Speakers Bureau for Eli Lilly & Co., Boehringer Ingelheim, Novo Nordisk, and Janssen.
GLP-1 receptor agonists vs. DPP-4 inhibitors for type 2 diabetes: is one approach more successful or preferable than the other?
Article first published online: 6 FEB 2014
© 2014 The Authors International Journal of Clinical Practice Published by John Wiley & Sons Ltd
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
International Journal of Clinical Practice
Volume 68, Issue 5, pages 557–567, May 2014
How to Cite
Brunton, S. (2014), GLP-1 receptor agonists vs. DPP-4 inhibitors for type 2 diabetes: is one approach more successful or preferable than the other?. International Journal of Clinical Practice, 68: 557–567. doi: 10.1111/ijcp.12361
- Issue published online: 20 APR 2014
- Article first published online: 6 FEB 2014
- Manuscript Accepted: OCT 2013
- Manuscript Received: JUL 2013
- Novo Nordisk Inc.
In patients with type 2 diabetes (T2D), incretin-based therapies improve glycaemic control with low incidence of hypoglycaemia and without weight gain, both advantages over traditional add-ons to metformin. Dipeptidyl peptidase-4 (DPP-4) inhibitors are administered orally and provide a physiological increase in glucagon-like peptide-1 (GLP-1) levels, while GLP-1 receptor agonists (GLP-1RAs) are injectable and deliver pharmacological levels of GLP-1RA. This review aims to distinguish between GLP-1RAs and DPP-4 inhibitors, and discuss when each may be favoured in clinical practice.
A MEDLINE search, limited to human clinical trials and using the search criteria ‘GLP-1RA’ or ‘DPP-4 inhibitor’, identified seven head-to-head studies and one relevant post hoc analysis (all a GLP-1RA vs. the DPP-4 inhibitor sitagliptin). In combination with treatment algorithms, product prescribing information and personal clinical experience, these studies were used to compare the efficacy and suitability of GLP-1RAs and DPP-4 inhibitors in patients with T2D.
In head-to-head clinical trials, GLP-1RAs provided greater glycaemic control, weight loss and overall treatment satisfaction vs. the DPP-4 inhibitor sitagliptin. Transient nausea was more frequent with GLP-1RAs and should be addressed through patient education and an incremental dosing approach. Current treatment algorithms recommend incretin-based therapy use after metformin failure, but local guidance may restrict their use.
GLP-1RAs provide superior glycaemic control and weight loss vs. DPP-4 inhibitors in patients with T2D. DPP-4 inhibitors may sometimes be preferred to a GLP-1RA if weight is not a concern, oral administration is a desirable feature or when a GLP-1RA cannot be tolerated.