Page 66 - 51 the significance--29.2_opt

Guidelines

DPP-4 inhibitors have become an important part of the T2DM treatment
strategy, to the extent where a number of the relevant guidelines make
specific recommendations concerning the use of these compounds in
people with this condition (Table 5).

Table 5. Guidelines concerning the use of DPP-4 inhibitors in people with diabetes
Organisation Recommendations*
American Association of Clinical Endocrinologists ● For HbA between 6.5% and 7.5%, DPP-4 inhibi-
1c
(AACE)/American College of Endocrinologists tors are one of four alternatives in monotherapy
(ACE) consensus statement (2009) 87 ● When progressing to dual therapy, they can be
used in combination with metformin or with TZD
● In triple therapy they are recommended for use in
combination with metformin plus TZD, glinides or
SU 87
American Diabetes Association (ADA) (2008) 88 ● No specific recommendations, but DPP-4 inhibitors
are expected to be listed with the next update 88
Consensus statement of the American Diabetes ● DPP-4 inhibitors not included, but the consensus
Association and the European Association for the statement emphasizes the following:
Study of Diabetes ADA/EASD (2009) 89 o Achievement and maintenance of near normo-
glycaemia (HbA < 7.0%)
1c
o Initial therapy with lifestyle intervention and
metformin
o Rapid addition of medications, and transition
to new regimens, when target glycaemic goals
are not achieved or sustained
o Early addition of insulin therapy in patients
who do not meet target goals. 89
UK Guidelines - NICE (2009) 90 ● A DPP-4 inhibitor instead of a SU as second-line
therapy to first-line metformin should be considered
when control of blood glucose remains or becomes
inadequate (HbA ≥ 6.5%, or other higher level
1c
agreed with the individual)
● Also, a DPP-4 inhibitor should be considered to
be added as second-line therapy to first-line SU
monotherapy when control of blood glucose re-
mains or becomes inadequate (HbA ≥ 6.5%, or
1c
other higher level agreed with the individual) and
the person does not tolerate metformin, or metfor-
min is contraindicated
● Consider adding sitagliptin as third-line therapy
to first-line metformin and a second-line SU when
control of blood glucose remains or becomes inad-
equate (HbA ≥ 7.5% or other higher level agreed
1c
with the individual) and insulin is unacceptable or
inappropriate.
● A DPP-4 inhibitor may be preferable to a TZD if:
o A further weight gain would cause or exacer-
bate significant problems associated with a
high body weight, or
o A TZD is contraindicated, or
o The person has previously had a poor
response to, or did not tolerate, a TZD. 90
International Diabetes Federation (IDF) guidelines ● DPP-4 inhibitors are not mentioned, but may be
(2005) included in future updates 91

66