Dipeptidyl peptidase 4 inhibitors in routine clinical practice: experiences from a Scottish teaching hospital

Abstract

Aims: This study aimed to assess the effect of dipeptidyl peptidase 4 inhibitors (DPP4i) on glycaemia and weight control and review adherence to renal dosing guidance in routine clinical practice.

Methods: A retrospective review of type 2 diabetes patients prescribed a DPP4i was undertaken in a general hospital. Date, type and dose of DPP4i, HbA1c, weight and renal function were recorded at initiation of DPP4i therapy and at the first follow-up appointment at least 3 months later.

Results: Between March 2008 and June 2012, 335 patients were initiated on DPP4i therapy of whom 263 were eligible for study inclusion (baseline median HbA1c 73 mmol/mol (IQR 65-83), median weight 90.8kg (IQR 79.7-104), approximately 74.8% with eGFR >50ml/min/1.73m2). Sitagliptin 100mg daily was the most commonly prescribed DPP4i (90.5%). Median time between DPP4i initiation and follow-up was 189 days (IQR 140-239). At follow-up there was a reduction in HbA1c (median -8.5 mmol/mol; 95%CI -10, -6.5; p<0.005) and body weight (median -0.45kg; 95% CI -1.15, -0.25, p0.033). At initiation the dose of DPP4i was appropriate for 87.7% of patients.

Conclusions: DPP4i are effective in reducing HbA1c and body weight in routine specialist secondary care. Inappropriate prescribing in 70% of patients with eGFR <50ml/min/1.73m2 prompted a review of prescribing practice.