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Related Concept Videos

Dipeptidyl Peptidase 4 Inhibitors01:23

Dipeptidyl Peptidase 4 Inhibitors

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Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
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Glucagon-like Receptor Agonists01:24

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Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
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Oral Hypoglycemic Agents: Biguanides and Glitazones01:26

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Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
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Oral Hypoglycemic Agents: α-Glucosidase Inhibitors01:19

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α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
Acarbose and miglitol are...
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Oral Hypoglycemic Agents: Glinides01:06

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Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
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Diabetes: Management and Pharmacotherapy01:15

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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Improving IV Insulin Administration in a Community Hospital
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DPP-IV inhibitors: Beyond glycaemic control?

Andrew J Kwok1, Meghavi Mashar1, Kaivan Khavandi2

  • 1Downing College, Regent Street, Cambridge CB2 1DQ, United Kingdom.

Trends in Cardiovascular Medicine
|December 4, 2013
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Summary

Dipeptidyl-peptidase-IV (DPP-IV) inhibitors for type 2 diabetes show uncertain cardiovascular benefits. Further research is needed to understand their complex physiological effects and true impact on cardiovascular risk.

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Area of Science:

  • Pharmacology
  • Endocrinology
  • Cardiovascular Medicine

Background:

  • Dipeptidyl-peptidase-IV (DPP-IV) inhibitors are a novel oral hypoglycemic agent class for type 2 diabetes.
  • Initial studies suggested cardiovascular benefits, including improved cardiac performance, blood pressure, and lipid profiles.
  • Recent clinical data raise questions about these purported cardiovascular advantages.

Purpose of the Study:

  • To evaluate the current understanding of DPP-IV inhibitors' physiological effects.
  • To assess the actual impact of DPP-IV inhibition on cardiovascular risk.
  • To determine if their use can be expanded beyond diabetes management.

Main Methods:

  • Review of existing clinical findings and physiological data on DPP-IV inhibitors.
  • Analysis of DPP-IV's broad substrate range beyond glucagon-like peptide 1.
  • Investigation into the alterations in cytokines and neuropeptides due to DPP-IV inhibition.

Main Results:

  • DPP-IV inhibition affects numerous substrates, complicating the understanding of its physiological actions.
  • The drug class impacts various cytokines and neuropeptides, suggesting widespread physiological effects.
  • Contradictory findings exist regarding the cardiovascular benefits initially suggested by early data.

Conclusions:

  • A comprehensive understanding of DPP-IV inhibitors' physiological effects is currently lacking.
  • The true impact of these agents on cardiovascular risk remains uncertain.
  • More research is essential before considering broader therapeutic applications beyond type 2 diabetes.