Hi friends I am at pains to present another note of dissent on this topic. The DPP-4 (dipeptidyl peptidase IV) mentioned here in Mohan’s article, arrived in the market only recently and within a short time this drug has caught hold of the market by storm. Such is the aggressive marketing strategy now. When introduced it was claimed that unlike the already existing OHAs this molecule alone is sufficient to tackle the type 2 diabetes. The old OHAs exhaust the pancreatic beta cells in due course. No question of hypoglycaemia. Later slowly they advocated adding metformin to this group if necessary. Still later they said that if found not sufficient, sulphonylurea drugs (they have forgotten about pancreatic damage these suphonylureas cause) and insulin can be added to the regime. From the point of the middle class section of the society, it is prohibitively costly. And if you combine other drugs as noted above it is going to be further costlier. But more than the cost aspect one point I want to make about this drug is that I am concerned about the side effect profile of this group of drugs. Among the old antidiabetic drugs we have none which is known to cause organ specific damage. Mind you, it is not so in the case of the new gliptin group of drugs. The sulphonylurea drugs and insulin are with us for so many decades now. We only have very minor side effects, most important being hypoglycaemia. If doctors are a little more cautious and educate the patients properly this is not a big problem. But it is not so in the case of gliptin group of drugs. After a person eats his food and blood sugar rises, hormones called incretin are released from intestinal cells. Incretin stimulates pancreatic beta cells to release insulin to metabolize sugar and signals the liver to stop making excess sugar. In people without diabetes, DPP-4 breaks down incretin to keep blood sugar and insulin levels balanced. When DPP-4 inhibitors given, the action of the DPP-4 is blocked. So incretin continues to stimulate pancreas to release insulin. Incretins help the body produce more insulin only when it is needed and reduce the amount of glucose being produced by the liver when it is not needed. Januvia (sitagliptin), a DPP-4 inhibitor, which comes under gliptin group is manufactured by Merck & Co. In clinical trials Januvia proved to be effective in controlling blood sugar levels. However, there are also reports of serious side effects, including acute pancreatitis, pancreatic cancer and thyroid cancer, which caused Januvia users to file lawsuits against Merck. In legal proceedings, plaintiffs accused Merck of negligence and concealing the risks of significant side effects. For several years the FDA has been getting reports that drugs in both families of incretin drugs were causing pancreatitis, a painful inflammation of the pancreas that can destroy large portions of it and lead to full-fledged Type 1 diabetes or even death DPP-4 was discovered through its association with the immune system, and some researchers thought that inhibiting it might impair the immune system Because it turns out that DPP-4 is also a tumor suppressor. And when you inhibit it, cells that have become cancerous get a 'get out of jail free' card. One of the most horrific parts of this is the fact that cancer can take decades to form — unless the drug dramatically speeds up the process by inhibiting your body's ability to suppress tumor growth. Merck's lethal drug Vioxx was only withdrawn from the market after its lethality became too obvious to ignore. Ditto for the dangerous diabetes drug Avandia. Those drugs caused heart attacks and stroke. Cancer, on the other hand is not something that will tend to make people keel over after a relatively short period of time. They could make MASSIVE amounts of money from these clearly dangerous drugs while cancer slowly and quietly grows in patients taking them, while biased shills maintain that the science is still "unclear." I for one would urge you to reconsider taking any kind of DPP-4 inhibitor. Why risk cancer for an ailment you can effectively address without ANY drug at all?
Just think about the logic (or rather, the lack thereof) of taking a drug that continuously inhibits one of your body's natural cancer suppressing mechanisms! According to Januvia's drug information, the drug inhibits the DPP-4 enzyme for 24 hours, and you take it daily, effectively permanently blocking the activity of a tumor suppressor gene. Yet none of the safety studies on Januvia addressed its impact on tumor growth! Is this wise? Friends, look at these reports. And still we doctors are coerced to give these medicines which are under cloud to our patients. Efficacy wise these drugs are on a par with other existing anti-diabetic drugs only. Their only claim was less of hypoglycaemia and no weight gain. It is as if we have no other alternate options in the management of diabetes. I have a large number of diabetic patients. But I have not given this drug to any of my patients so far. Till I get a good report clearing all the suspicions about this class of drugs I will not prescribe this drug to any of my patients. I may sound a little anachronistic, not keeping pace with the current trends. That is my way.
UA Mohammed
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