Related Experiment Video
Updated: Mar 7, 2026
08:15
Understanding the Changes in Mitochondrial Morphology through Dynamic and Three-dimensional Fluorescence Micrographs
Published on: August 15, 2025
1.2K
PURLs: Need an add-on to metformin? Consider this
David Wyncott1, Corey Lyon2, Anne Mounsey3
1Saint Joseph Health System Family Medicine Residency, Mishawaka, IN, USA.
The Journal of Family Practice
|February 12, 2017
Summary
For type 2 diabetes, dipeptidyl peptidase-4 inhibitors (DPP-4s) show lower risks of death, cardiovascular events, and hypoglycemia compared to sulfonylureas when added to metformin.
Area of Science:
- Endocrinology
- Pharmacology
- Cardiovascular Medicine
Background:
- Metformin is a first-line therapy for type 2 diabetes mellitus (T2DM).
- Sulfonylureas have been a common second-line add-on therapy to metformin.
- Alternative add-on therapies are needed to improve patient outcomes and safety.
Observation:
- This study compared the risks associated with sulfonylureas versus dipeptidyl peptidase-4 inhibitors (DPP-4s) as add-on therapy to metformin in T2DM patients.
- The analysis focused on mortality, major adverse cardiovascular events (MACE), and hypoglycemia.
Findings:
- DPP-4 inhibitors were associated with significantly lower risks of all-cause death compared to sulfonylureas.
- The risk of major adverse cardiovascular events was also reduced in patients treated with DPP-4 inhibitors.
- Hypoglycemia events were substantially less frequent in the DPP-4 inhibitor group.
Implications:
- DPP-4 inhibitors represent a safer alternative to sulfonylureas for T2DM patients inadequately controlled by metformin.
- These findings may shift clinical guidelines towards DPP-4 inhibitors for improved patient safety and reduced adverse events.
- Further research should explore long-term comparative effectiveness and cost-effectiveness.
Related Concept Videos
01:26Oral Hypoglycemic Agents: Biguanides and Glitazones
769
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...
769
01:06Oral Hypoglycemic Agents: Glinides
784
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...
784
01:23Dipeptidyl Peptidase 4 Inhibitors
821
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...
821
01:19Oral Hypoglycemic Agents: α-Glucosidase Inhibitors
713
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...
Acarbose and miglitol are...
713
01:17Oral Hypoglycemic Agents: Sulfonylureas
1.4K
Sulfonylureas are oral hypoglycemic agents utilized in treating type 2 diabetes. They are characterized by their unique sulfonylurea chemical structure. The family of sulfonylureas is divided into generations. First-generation sulfonylureas, including tolbutamide (Orinase), chlorpropamide (Diabinese), and tolazamide (Tolinase), trigger insulin release from pancreatic β cells and enhance peripheral tissues' insulin sensitivity. The second-generation members, such as glipizide...
1.4K
01:16Insulin: Dosing Regimen and Adverse Effects
991
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
991