[Use of dipeptidyl peptidase-4 inhibitors in patients with diabetes]. / Seguridad de los inhibidores de la dipeptidil peptidasa 4.

New drugs have been added to the treatment of type 2 diabetes mellitus. These drugs have represented an advance in the physiopathological approach to the disease, with the possibility of acting on the different mechanisms involved in raised blood glucose levels and allowing treatment to be individualised, as recommended in clinical practice guide-lines and consensus documents. The incretins were added to the therapeutic arsenal of diabetes in 2006. This group in-cludes glucagon-like peptide-1 receptor antagonists and dipeptidyl peptidase-4 inhibitors (marketed in Spain in 2007), which act on the incretin system in the gut, reducing glycae-mia, with a decreasing or neutral effect on weight and with a low risk of hypoglycaemic episodes. Their introduction coincided with the publication of the controversial results of studies on intensive glycemic control, leading the Food and Drug Administration (2008) to require demonstration of the cardiovascular safety of new glucose-lowering drugs. The publication of subsequent studies has demonstrated cardiovascular safety and some have shown cardiovascular and survival benefits. These results are modifying the recommenda-tions of the clinical practice guidelines and consensus documents on the treatment of type 2 diabetes. The present article describes the main pharmacological and cardiovascular characteristics of the safety and tolerability of dipeptidyl peptidase-4 inhibitors, which need to be known and updated in primary care, given their wide prescription and the need for correct use of drug therapy in type 2 diabetes.

Seguridad de los inhibidores de la dipeptidil peptidasa 4 / Use of dipeptidyl peptidase-4 inhibitors in patients with diabetes

En el tratamiento de la diabetes mellitus tipo 2 se han introducido nuevos fármacos que han supuesto un avance en el abordaje fsiopatológico, con la posibilidad de actuar sobre los diferentes mecanismos implicados en la elevación de la glucemia y que permiten la individualización del tratamiento, como se recomienda en las guías y consensos al respecto. Al arsenal terapéutico de la diabetes se incorporó el grupo de las incretinas (2006), al que pertenecen los agonistas del receptor del péptido similar al glucagón 1 y los inhibidores de la enzima dipeptidil peptidasa 4, comercializados estos últimos en España en 2007, que actúan en el sistema incretínico del intestino reduciendo la glucemia, con efecto reductor o neutro en el peso y con bajo riesgo de hipoglucemias. Su introducción coincidió con la publicación de los controvertidos resultados de los estudios de control intensivo de la glucemia, que originó la normativa de la Food and Drug Administration (2008) que obliga a los nuevos fármacos hipoglucemiantes a demostrar su seguridad cardiovascular. La publicación de estos estudios ha evidenciado la seguridad cardiovascular y, en algunos de ellos, benefcios cardiovasculares y en la mortalidad, que están modifcando las guías y consensos sobre el tratamiento de la diabetes tipo 2. En este artículo se recogen las principales características sobre la seguridad y tolerancia de los inhibidores de la enzima dipeptidil peptidasa 4, a nivel farmacológico y cardiovascular, que es necesario conocer y actualizar en atención primaria, por su amplio uso y para un correcto abordaje de la terapia farmacológica en la diabetes tipo

New drugs have been added to the treatment of type 2 diabetes mellitus. These drugs have represented an advance in the physiopathological approach to the disease, with the possibility of acting on the different mechanisms involved in raised blood glucose levels and allowing treatment to be individualised, as recommended in clinical practice guide-lines and consensus documents. The incretins were added to the therapeutic arsenal of diabetes in 2006. This group in-cludes glucagon-like peptide-1 receptor antagonists and dipeptidyl peptidase-4 inhibitors (marketed in Spain in 2007), which act on the incretin system in the gut, reducing glycae-mia, with a decreasing or neutral effect on weight and with a low risk of hypoglycaemic episodes. Their introduction coincided with the publication of the controversial results of studies on intensive glycemic control, leading the Food and Drug Administration (2008) to require demonstration of the cardiovascular safety of new glucose-lowering drugs. The publication of subsequent studies has demonstrated cardiovascular safety and some have shown cardiovascular and survival benefits. These results are modifying the recommenda-tions of the clinical practice guidelines and consensus documents on the treatment of type 2 diabetes. The present article describes the main pharmacological and cardiovascular characteristics of the safety and tolerability of dipeptidyl peptidase-4 inhibitors, which need to be known and updated in primary care, given their wide prescription and the need for correct use of drug therapy in type 2 diabetes