Table 1 Comparison of GLP-1R agonists and DPP-4 inhibitors.
| GLP-1R Agonists | DPP-4 Inhibitors | |
|---|---|---|
| Agents currently available in U.S. with dosing information (normal renal function)[31–35] |
• Exenatide 5-10 mcg SC BID • Liraglutide 1.2-1.8 mg QD |
• Sitagliptin 100 mg PO QD • Saxagliptin 2.5-5 mg PO QD • Linagliptin 5 mg PO QD |
| Benefits | ||
| Reduction in A1C level*[22–24, 26, 29, 36–45] | 0.5%-1.5% | 0.5%-0.9% |
| Reduction in fasting plasma glucose*[29, 39–41, 49–51] | ↓7 to 74 mg/dL | ↓11 to 29 mg/dL |
| Reduction in postprandial glucose*[9, 27, 51, 54, 55] | ↓41 to 47 mg/dL | ↓49 to 68 mg/dL |
| Weight effect [14, 22, 24, 26, 29, 37, 39–41, 44, 45, 49, 50, 52, 60] | ↓1-4 kg | ↓0.9 to ↑1.4 kg |
| Effect on triglycerides [24, 29, 36, 37, 39, 41, 49, 60, 62] | ↓12-40 mg/dL | ↑16 mg/dL to ↓35 mg/dL |
| Reduction in systolic blood pressure [13, 14, 24, 29, 36, 37, 39, 41, 49, 60, 62] | ↓1-7 mm Hg | 0 to ↓3.9 mm Hg |
| May improve markers of pancreatic β-cell function (such as homeostasis model assessment-β-cell function, fasting insulin, fasting proinsulin to insulin ratio, fasting C-peptide)[8, 13, 22–24, 26, 30] | ✓ | ✓ |
| Disadvantages | ||
| Incidence of mild/moderate hypoglycemia**[9, 10, 24, 26, 36–39, 41, 43–45, 52, 55, 64] | 0%-12% | 0%-4% |
| Nausea [13, 33–35] | 26%-28% | 0-1% |
| Hypersensitivity reactions [33–35] | Rare (exenatide) | ✓ |
| Antibody formation [31–35, 79, 80] | 30-67% E; 8% L | NR |