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Table 3. DPP-4 inhibitors – Strengths, Weaknesses, Opportunities and Threats.

Strengths Weaknesses

z Potentiate the activity of GLP-1 and enhance z Long-term data lacking
glucose-dependent insulin secretion
z Dose adjustment required or contraindicated in
z Associated with a low incidence of hypoglycaemia moderate or severe renal impairment (except
linagliptin)
z Weight neutral
z Significant body of data supporting their use in z Safety concerns with vildagliptin
T2DM z Price
z Orally active z Not specifically included in all guidelines, but are
included in the ADA/EASD consensus guidelines
z No titration period required
z Shown to be effective in mono- and combination
therapy

z Placebo-like tolerability
Opportunities Threats
z May confer some degree of cardio-protection z Possible safety issues related to long-term conse-
quences of DPP-4 inhibition
z T2DM management is moving beyond simple
glycaemic parameters z Possible safety issues related to inadvertent inhibi-
tion of DPP-8 and DPP-9
z The position of many OADs is being eroded by
safety concerns (e.g. SUs, TZDs) z Negative data from CV outcome studies
z Patient-centric treatment is increasingly important z New compounds with novel modes of action
z Positive data from CV outcome studies

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