“Heredity loads the cannon, but it is the environment that lights the fuse,” said Dr. Ricardo Fernando, founder and president of the University of the East Institute for the Studies on Diabetes during the recent 9^th Ricardo Fernando Professional Lecture held at the EDSA Shangri-La Hotel, Mandaluyong City. In previous years, heredity was believed to be the major contributor in the development of type 2 diabetes. “Today, it appears that the environment plays an even bigger role,” Dr. Fernando elaborated.

Experts say that a person’s ‘environment’ can be controlled by keeping the body weight down, eating a sensible diet low in fat (triglycerides and ‘bad’ cholesterol), and engaging in regular physical activity. “Unfortunately not many people are committed to exercise and dietary changes, thus the need for intervention through medication,” said guest lecturer Dr. Zachary Bloomgarden, clinical professor of the Mount Sinai School of Medicine in New York, USA.

Medication may be necessary to keep incretin levels up and active. Incretins particularly GIP (glucose-dependent insulinotropic polypeptide) and the GLP-1 (glucagon-like peptide1) are known to play a very important role in controlling blood sugar levels explained Dr. Bloomgarden. These two incretins are released in the gut (gastrointestinal tract) whenever a person eats, and are responsible for stimulating the pancreas’ beta-cells to produce insulin, which helps keep a person’s blood sugar level down when it is elevated. The GLP-1 incretin has also been found to inhibit the pancreas’ alpha-cells to release glucagon, which causes the liver to produce and release glucose (sugar) into the bloodstream when a person’s blood sugar level is low. When these two incretins are unable to do their work properly, an imbalance of blood sugar levels often results. Experts have observed that a progressive loss of beta-cell function occurs among type 2 diabetic patients.

Along with the incretins, an enzyme called DPP-4 (dipeptidyl peptidase-4) has also been found to exist. The DPP-4 inactivates and shortens the life of the GIP and GLP-1 incretins. To address this problem, a medication called sitagliptin was developed to effectively inhibit the activity of the DPP-4. Sitagliptin is an orally-active inhibitor of the DPP-4 enzyme. It increases and prolongs active incretin levels, which in turn, increases insulin release and decreases glucagon levels. It is specifically indicated for the improvement of blood sugar control in patients with type 2 diabetes as a monotherapy or combined with metformin. Sitagliptin is the first in a new class of drugs known as dipeptidyl peptidase-4 (DPP-4) inhibitors which enhance the body’s own ability to lower blood sugar (glucose) when it is elevated. The mechanism of action of DPP-4 inhibitors is distinct from that of any currently available class of glucose-lowering agents.

In clinical studies, sitagliptin was shown to reduce blood sugar levels effectively when used as a monotherapy, however, when used together with metformin in combined therapy, the blood sugar level reduction benefit was doubled explained Dr. Bloomgarden. Sitagliptin was also shown not to cause weight gain and hypoglycemia (sudden drop in blood sugar level), which are common problems encountered when using other types of diabetes medications. With this, sitagliptin offers a new and effective approach to blood sugar control without the usual side effects.

Sitagliptin is a new diabetes medicine developed by pharmaceutical company Merck Sharp & Dohme (MSD). MSD discovers, manufactures, and market medicines and vaccines that help address the needs of patients. If you want to know more about new medicines for type 2 diabetes, it is best to consult your doctor.