GLP-1 and DPP-4 inhibitors are classes of drugs that have garnered interest in their ability to manage diabetes and potentially protect against cardiovascular disease. These drugs are being tested as new diabetes medication.
Type 2 diabetes is a condition in which the body cannot regulate the levels of sugar or glucose in the blood. Normally glucose is regulated by the hormone insulin which helps deliver glucose from the blood and into the cells where it is used for energy. Patients with type 2 diabetes have poor functioning insulin and/or cells that no longer respond to insulin meaning that glucose remains in the blood.
The regulation of glucose is vital since low blood glucose (hypoglycemia) can cause dizziness, fainting and even induce coma; and high levels of blood glucose (hyperglycemia) can damage blood vessels and organs such as the eyes and kidneys. Type 2 diabetes is also associated with an increased risk of cardiovascular disease and cardiovascular-disease related death. There is currently no cure for diabetes so treatment focuses on managing the condition rather than eradicating it.
Fortunately, treatment of type 2 diabetes has made great progress over the decades with the introduction of oral anti-diabetic medications such as metformin and/or insulin injections. Various classes of diabetes medications have been assessed for their effectiveness and their ability to improve longevity. Results of these studies suggest that although these drugs are effective in controlling diabetes, they may not improve longevity.
GLP-1 is a hormone that promotes the release of insulin from the pancreas. Interestingly, GLP-1 only promotes insulin release during times of elevated blood glucose levels. This is a very important consideration because insulin release during times of normal glucose levels can be dangerous and cause low blood glucose which can result in fainting, dizziness and possible coma.
GLP-1 also appears to promote the growth of cells which release insulin, meaning that GLP-1 medications may improve the ability of insulin to work. Additionally, GLP-1 is known to increase the feeling of fullness by slowing the rate at which carbohydrates are digested and released into the blood stream (as glucose).
DPP-4 is an enzyme that breaks down GLP-1 so DPP-4 inhibitors are used as an adjunct treatment to preserve GLP-1 in the body.
Clinical trials have found that the administration of such drugs to patients with previous heart attacks showed improvement in heart function1. As a result, researchers believe that GLP-1 and DDP-4 treatments may prevent death associated with cardiovascular disease by protecting the heart itself.
More research is required and ongoing to determine whether these new classes of drugs can improve not only glucose management but also cardiovascular risk among patients with type 2 diabetes.