Priorities in effective and safe glycemic control: Alogliptin in type 2 diabetes mellitus treatment

Type 2 diabetes mellitus (T2DM) is a severe disease associated with the development of serious chronic complications without targeted glycemic control. Discussion of issues of effective and affordable treatment of T2DM is of the most immediate interest. Recent years have seen a significant expansion of the glucose-lowering drug arsenal, which resulted from a deeper insight into the mechanisms of diabetes mellitus development. The significance of the entero-insular axis (EIA), the incretin system (glucagon-like peptide type 1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP)) in the regulation of carbohydrate metabolism has been discovered. Inhibitors of dipeptidyl peptidase-4 (DPP-4is), also known as “gliptins”, belong to the group of incretin-based glucose-lowering drugs. The article discusses the mechanisms of action of DPP-4is and highlights the advantages of this group of drugs. Gliptins act on the major pathophysiological defect in T2DM – pancreatic β-cell dysfunction. GLP-1 is the most important for their glucose-lowering action. DPP-4is extend the half-life and availability of endogenous GLP-1 by inhibiting DPP-4. The use of DPP-4is is not accompanied by the development of hypoglycemia or weight gain, and is included in the algorithms for treating the disease in the early stages of T2DM. The article is devoted to the choice of the right drug from the DPP-4is group. It presents the results of clinical studies evaluating the efficacy, tolerability and safety of alogliptin, and data from studies comparing alogliptin with other glucose-lowering drugs. The therapeutic advantages of alogliptin are discussed. The drug has shown its effectiveness as monotherapy and as part of combination therapy in T2DM. The advantages of alogliptin and metformin combination are considered. The multi-directional action of these drugs on the pathogenetic mechanisms of T2DM leads to an increase in pharmacological effects. The importance of rational combinations of glucose-lowering drugs is emphasized. The information provided in the review concerning effective and safe glycemic control in patients with T2DM should help health professionals to make decisions in their daily clinical practice.