A Study on the Current Prescribing Patterns of Dipeptidyl Peptidase

(DPP-4) Inhibitor at BIRDEM hospital, Bangladesh

Presented By: Samya Sayantan Halder

Id: 121-29-381Department of Pharmacy

AbstractThis study aims to evaluate the current prescribing pattern of

DPP-4 inhibitors at BIRDEM hospital, Bangldesh.during the survey, 150 prescriptions were collected and investigated where only 49% DPP-4 inhibitors – Sitagliptin, Linagliptin, Vildagliptin are prescribed even along with other conventional oral hypoglycemic drug. According to this survey, it is clear that Dipetidyl Peptidase (DPP-4) inhibitors is becoming more popular day by day in the management of hyperglycemia in Type-2 Diabetes without causing weight gain or hypoglycaemia in Bangladesh.

Diabetes Mellitus

Diabetes Mellitus (DM) is a metabolic disorder of which inappropriate hyperglycemia is the hallmark.

Most symptoms secondary to hyperglycemia: Polyuria (excessive urination) Polydipsia (excessive thirst) Polyphagia (excessive eating)

Types of DiabetesType -1 Diabetes failure to produce enough insulin results in insulin dependence commonly detected before 30Type-2 Diabetes A disease of progressive β-cell dysfunction in presence of

insulin resistance possibly abnormalities in secretion or response to incretin

hormones Eventually leads to β-cell failure (resulting in insulin dependence)Gestational Diabetes The hormones produced during pregnancy can make it difficult for

women’s body to use insulin properly.

Anti-Diabetic MedicationTreatments include :(1) Agents that increase the amount of insulin

secreted by the pancreas, (2) Agents that increase the sensitivity of

target organs to insulin, and (3) Agents that decrease the rate at which

glucose is absorbed from the gastrointestinal tract

Oral Hypoglycemic Drugs Sulfonylurea (Glimepiride, Glyclazide) Biguanides (Metformin) Meglitinides (Repaglinide) Thiazolidinedione (Pioglitazone) α- glucosidase inhibitor (Acarbose) DPP-4 inhibitors (Sitagliptin,Vildagliptin)*DPP-4I: Dipeptidyl Peptidase-4 Inhibitor

Dipeptidyl Peptidase (DPP-4) Inhibitors

DPP-4 inhibitors or gliptins are a class of oral hypoglycemic that block DPP-4 which can be used to treat diabetes mellitus Type-2.

Dipeptidyl peptidase-4 (DPP-4) inhibitors increase blood concentration of the incretin GLP-1 by inhibiting its degradation by dipeptidyl peptidase-4.

Available DPP-4 Inhibitors in Bangladesh

Sitagliptin (Glipita, Sitagil) Viladagliptin (Galvus, Dialiptin) Linagliptin (Linatab, Linadi)

Mechanism of Action of DPP-4 Inhibitor

DATA PRESENTATION

Drug class Prescription Quantity Percentage(%)DPP- inhibitors 73 48.6

Others hypoglycemic drugs 77 51.3

Comparison of percentage (%) between prescribed DPP-4 inhibitors and other conventional Hypoglycemic Drugs (total prescription=150)

DPP-4I49%

Others51%

Percentage(%)

Generic name Prescription quantity Percentage (%)Sitagliptin 44 60.2

Linagliptin 19 26

Vildagliptin 10 13.6

Comparison of percentage (%) of prescribed DPP-4 inhibitors ( total prescription=73)

Sitagliptin 60%

Linagliptin26%

Vildagliptin14%

Percentage (%)

Sl.no DPP-4 Inhibitor as No.Prescription (%) (n=150)

1 1st Line DPP-4I 5 (3.33)

2 2nd LineMetformin+DPP-4ISU+DPP-4IInsulin+DPP-4I

109 (72.7)44 (29.3)45 (30)20 (13.3)

3 3rd LineMetformin+Insulin+DPP-4IMetformin+SU+DPP-4ISU+Insulin+DPP-4I

37 (24.6)10 (6.6)24 (16)3 (2)

4 4th Line Metformin+SU+Insulin+DPP-4I

3 (2)

Comparison of DPP-4 Inhibitors as 1st line, 2nd line, 3rd line, 4th line

*DPP-4I: Dipeptidyl Peptidase-4 Inhibitor

CONCLUSION

My evaluation revealed the mostly prescribed DPP-4 inhibitor to be Sitagliptin. Maximum benefit of the gliptins can be achieved when initiated in the earlier stages of DM. As DPP-inhibitors are recently approved drugs but it becoming popular day by day to the doctor of BIRDEM hospital to treat Type-2 Diabetes Mellitus because of its promising treatment modality in Type-2 Diabetes Mellitus.