How Vildagliptin Improves Time in Range in T2DM patients ft-Prof. Dr Aravinda Jagadeesha

In this video, Prof. Dr Aravinda Jagadeesha, a diabetologist and the chairman at Dr. Aravinds Diabetes Centre in Bengaluru, India shares his opinion on the use of Vildagliptin to better the profile of Time in Range in patients with type 2 diabetes mellitus.

The two most widely used gliptins, sitagliptin and vildagliptin, are chemically distinct species with different characteristics of binding to DPP-4. Whereas Sitagliptin is competitive inhibitor, Vildagliptin acts as a substrate for the enzyme forming a reversible covalent complex with the catalytic site of DPP-4 that dissociates slowly, eliciting prolonged DPP-4 inhibition. This raises intact GLP-1 levels, not only after meal ingestion but also in the fasting state, and maintains suppressed glucagon levels and decreased hepatic glucose production overnight. This also results in a better glycemic variability profile.

Several studies have also demonstrated that Vildagliptin affords better circadian glucose control and lower glycemic variability with better Time in Range than sitagliptin, mainly driven by a reduction in basal hyperglycaemia.

Vildagliptin is typically used in combination with metformin but can also be used concurrently with empagliflozin, sulfonylurea, pioglitazone or basal insulin.

Several studies have documented that in people with type 2 diabetes who are already taking metformin, adding vildagliptin once or twice daily to their treatment regimen reduces HbA1c levels by a further 7 – 12 mmol/mol after 12 weeks of treatment. When vildagliptin is used alone in people who do not tolerate metformin, it reduces HbA1c levels by an average of 6 – 9 mmol/mol. This is in line with the current diabetes treatment programs which aim at lowering HbA1c levels.

This points up the benefit of the early addition of Vildagliptin to metformin without waiting for glucose control to further deteriorate while not exposing patients to an increased risk of hypoglycaemia-