[Recommendations of the main clinical practice guidelines]

Area of Science:

• Endocrinology
• Pharmacology
• Clinical Practice Guidelines

Background:

• Recent cardiovascular safety studies necessitate updated clinical practice guidelines for type 2 diabetes mellitus (T2DM).
• Metformin remains the established first-line therapy for T2DM management.
• The increasing prescription of dipeptidyl peptidase-4 (DPP-4) inhibitors in primary care warrants a review of their current role.

Purpose of the Study:

• To evaluate the current position of DPP-4 inhibitors in T2DM treatment guidelines.
• To assess the clinical utility of DPP-4 inhibitors in primary care settings.
• To compare the benefits and risks of DPP-4 inhibitors against newer antidiabetic drug classes.

Main Methods:

• Review of current clinical practice guidelines and consensus documents on T2DM management.
• Analysis of pharmacological characteristics of DPP-4 inhibitors, including drug-drug interactions, tolerability, weight effects, and hypoglycemia risk.
• Comparative assessment of DPP-4 inhibitors with sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists regarding cardiovascular outcomes.

Main Results:

• DPP-4 inhibitors are oral, well-tolerated lipid-lowering drugs with minimal drug interactions and a neutral effect on weight.
• They are recommended as second-line agents or first-line if metformin is contraindicated or not tolerated.
• Emerging evidence highlights cardiovascular benefits of SGLT-2 inhibitors and GLP-1 receptor agonists, potentially challenging the role of DPP-4 inhibitors.

Conclusions:

• DPP-4 inhibitors offer a favorable profile for primary care due to their safety and ease of use.
• Their established role may be influenced by newer agents demonstrating significant cardiovascular benefits.
• Further evaluation is needed to define the optimal place of DPP-4 inhibitors in evolving T2DM treatment paradigms.