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DPP-4 Antagonists: Benefits, Risks, and the Future

DPP-4 Antagonists: Benefits, Risks, and the Future

Payal Kohli, MD, UCSF
Darren K McGuire, MD, MHSc

Will dipeptidyl peptidase-4 (DPP-4) antagonists find a secure position in the hierarchy of antidiabetes agents? Many signs point to “yes” for the fastest growing class of antihyperglycemic drugs: 
• Well tolerated
• Weight neutral
• Do not promote hypoglycemia
• Can be used in combination with traditional first-line agents
• Confer 0.5% to 1% additional reduction in A1C

Questions remain, however, about long-term safety of the DPP-4 inhibitors and their effects on cardiovascular outcomes, if any. In particular, an early signal for increased pancreatitis with some but not all members of this drug class, along with a small numeric excess of pancreatic cancer cases in some studies are now being systematically assessed for all  agents in the class. How should primary care physicians approach these agents and which patients might be candidates? 

DPP-4 Antagonists

DPP-4 Antagonists


In this short podcast, Dr Payal Kohli, host of CardiologyNow talks to Dr Darren McGuire about the DPP-4 antagonist class and the drugs’ benefits and risks as they are currently known. Dr Kohli is a cardiology fellow at the University of California San Francisco and Dr McGuire is Associate Professor of Medicine at UT Southwestern Medical Center, in Dallas; Associate of the Donald W. Reynolds Cardiovascular Clinical Research Center, and Director of the Parkland Hospital and Health System Outpatient Cardiology clinics. He is also senior editor of Diabetes and Vascular Disease Research, and associate editor of the American Heart Journal.

Take-home Points and Suggested Reading on next page...


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