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SGLT2 Inhibitor and DPP4 Inhibitor Co-Administration In Type 2 Diabetes -Are We Near The Promised Land?

Ayesha Vaseem, Bipin K Sethi, Jayant V Kelwade, Mazher Ali

Diabetes is progressive disease needing multiple drugs for achieving and maintaining good glycemic control. The drugs with different mechanisms of action are administered either alone or as fixed dose combinations. Usually the combined effect of each is less than the added effect except with Metformin DPP-4 inhibitor combination because they seldom complement/synergise each other’s action. More of such effective drug combinations that provide glycemic control are needed. SGLT 2 inhibitor, when combined with DPP4 inhibitor has the potential to be that ideal combination. Both of these drugs address different pathophysiological mechanisms for hyperglycemia and when combined provide reductions in HbA1c level with no inherent risk of hypoglycaemia. Genitourinary infection, a major hindrance with SGLT 2 inhibitor use are potentially reduced when it is combined with DPP4 inhibitor, which also can counteract the increase in glucagon level produced by the former. Cost, differing applicability in patients with renal dysfunction and limited clinical experience restricts the universal application of this combination as first line agents.