Published online Jun 15, 2022. doi: 10.4239/wjd.v13.i6.466
Peer-review started: March 7, 2022
First decision: April 17, 2022
Revised: April 19, 2022
Accepted: May 21, 2022
Article in press: May 21, 2022
Published online: June 15, 2022
Processing time: 92 Days and 8.3 Hours
SGLT-2 inhibitors (SGLT-2Is) have significantly improved cardio-renal outcomes and are preferred agents in people with cardiovascular diseases, heart failure, and diabetic kidney disease. Similarly, GLP-1 receptor agonists (GLP-1RAs) have significantly improved atherosclerotic cardiovascular outcomes. To this end, DPP-4 inhibitors (DPP-4Is) are cardiac-neutral drugs. While long-acting GLP-1RAs have shown a favorable HbA1c lowering compared to DPP-4Is, there is no clinically meaningful HbA1c lowering difference between SGLT-2Is vs DPP-4Is. Moreover, the glucose-lowering potential of SGLT-2Is gets compromised with a progressive decline in renal functions, unlike DPP-4Is. Furthermore, the HbA1c lowering potential of DPP-4Is is favorable in people with T2DM having a modest baseline HbA1c (8.0%-8.5%) compared with SGLT-2Is which lowers HbA1c larger in a background of higher baseline HbA1c (> 8.5%-9.0%). These findings suggest that the role of DPP-4Is in the management of type 2 diabetes mellitus cannot be completely ignored even in the era of SGLT-2Is.
Core Tip: Despite the newer anti-diabetic agents such as SGLT-2 inhibitors (SGLT-2Is) and GLP-1 receptor agonists have taken the center stage in the management of type 2 diabetes mellitus due to additional cardiac and renal benefits, the role of DPP-4 inhibitors (DPP-4Is) cannot be undermined. HbA1c lowering potential of DPP-4Is are nearly similar to SGLT-2Is and surprisingly larger in a background of modest baseline HbA1c compared with SGLT-2Is. Moreover, the HbA1c lowering abilities of SGLT-2Is are compromised with declining renal function while DPP-4Is reduce HbA1c favorably in people with chronic kidney disease regardless of impaired kidney functions.