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

Published On 2023-01-10T11:00:20+05:30  |  Updated On 2023-01-10T16:19:24+05:30

Overview

The increased alpha and beta cell sensitivity to glucose by DPP4 inhibitors modulate not only chronic hyperglycemia but also daily glucose profiles and variability.

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-

Speakers

Dr. Nandita Mohan

BDS, MDS( Pedodontics and Preventive Dentistry)

Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751
Vildagliptin Vildagliptin 100mg SR vildagliptin SR jalra Jalra DP Jalra OD Dr Aravinda Jagadeesha diabetes drugs T2D patients circadian glucose control glycemic variability Hyperglycemia time in range time in range in T2DM 
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