The DPP-4 Inhibitor: Lowers Blood Glucose by Working on the Gut

By using a DPP-4 inhibitor, you can help hormones work more efficiently and fine-tune blood glucose levels even better. Here's what you need to know about this medication.



Januvia (sitagliptin phosphate), from Merck and Co., was the first DPP-4 inhibitor to be approved by the U.S. Food and Drug Administration in October 2006. Several more DPP-4 inhibitors should become available in the next few years. So what's all the fuss about the DPP-4 inhibitor category of medications that lower blood glucose? They work in an entirely different way than most other diabetes medications. They inhibit an enzyme in the gut that breaks down the hormones that help to lower your blood glucose.

How It Works

DPP-4 (dipeptidyl peptidase IV) is an enzyme that's responsible for inactivating hormones in your gut called incretins. These helpful incretin hormones cause your pancreas to produce more insulin and your liver to stop producing glucose. By depressing or inhibiting the DPP-4 enzyme that inactivates incretins, DPP-4 inhibitors promote higher levels of incretins to keep your blood glucose in the normal range, especially after meals.

DPP-4 inhibitors are designed for people with type 2 diabetes to use in conjunction with a healthful meal plan and sufficient physical activity to control their blood glucose levels, especially when glucose levels soar following meals. They work in the presence of food or in response to a meal.

"I see many people with diabetes who aren't able to get good control because of high postmeal blood glucose," says Joel Rosenberg, M.D., a cardiac surgeon in upstate New York. "Januvia is a great option for people who are having trouble with postmeal high glucose levels." However, DPP-4 inhibitors don't reduce overall blood glucose levels as well as some other oral medications that are in the same price range.