This site is intended for health professionals only

DPP-4 inhibitors now included for type 2 diabetes in Scotland

A new guideline for the treatment of type 1 and type 2 diabetes in Scotland has been issued by the Scottish Intercollegiate Guidelines Network (SIGN).

The guideline includes direction on the use of newer agents, including DPP-4 inhibitors, positioning them as secondline and thirdline therapy for type 2 patients where there is a significant concern around hypoglycaemia and/or weight gain.

Where there is significant concern about weight gain or congestive heart failure, DPP-4 inhibitors may be preferable to a thiazolidinedione (TZD). Sitagliptin, a DPP-4 inhibitor, is currently the only treatment in this class licensed for use in triple therapy in the UK. This follows acceptance of sitagliptin by the Scottish Medicines Consortium (SMC) for use in Scotland in 2008.

DPP-4 inhibitors have been shown to lower blood sugar levels with comparable efficacy to a sulphonylurea (SU), with a reduced risk of hypoglycaemia, a common side-effect associated with older treatments such as SUs, and weight gain, seen with both SUs and TZDs.

Side-effects can represent a barrier to compliance with therapy and can have significant impact on the patient. For example, SU therapy results in more than 5,000 patients in the UK requiring emergency intervention following a severe hypoglycaemic event, each year.

In Scotland, approximately 190,000 people are affected by type 2 diabetes and this is increasing by about five percent each year. The Scottish Government recently launched its strategy to tackle obesity, and the BMA have called for urgent action to address the soaring obesity rates in Scotland, highlighting the close link to developing type 2 diabetes.

Dr Richard Quigley, a Glasgow GP and Primary Care Diabetes Society Committee Chair for Scotland, commented; "Diabetes incidence is growing at an alarming rate in Scotland, and so guidelines such as those issued by NICE last year, and today by SIGN for Scotland specifically, are very timely.

They provide clarity to physicians by positioning the use of the newer agents such as DPP-4 inhibitors. DPP-4 inhibitor use is already increasing in Scotland, and the new SIGN guideline today further supports these treatments as a new option in the diabetes treatment paradigm."

Scottish Intercollegiate Guidelines Network