- Certain diabetes drugs like
dipeptidyl peptidase-4 inhibitors may increase the risk of inflammatory
- Dipeptidyl peptidase-4 inhibitors
are a new kind of diabetes drug prescribed to
patients who do not respond to other diabetes drugs
- The findings need to be
replicated, but physicians should be made aware of this possible
A new type of
diabetes drug known as dipeptidyl peptidase-4 (DPP-4) inhibitors may be
associated with an increased risk of inflammatory bowel disease, finds a study
conducted by a Canadian research team at the McGill University.
In the study
published in journal The BMJ,
the research team say
that the findings of the study need to be replicated. However, physicians
should be made aware of this possible association.
Peptidase-4 (DPP-4) Inhibitors
are a new type of diabetes drug prescribed to lower high blood sugar levels in
patients with type 2 diabetes
who do not respond well to other
antidiabetic drugs. These drugs block the DPP-4 enzyme that is involved in the
body's inflammatory response and regulate gut hormones. In patients with
inflammatory bowel disease, low serum levels of the DPP-4 enzyme is linked to
increased disease activity, according to recent studies. But no study has
investigated the impact of inhibiting the enzyme on the occurrence of the
‘The use of antidiabetic drug dipeptidyl peptidase-4 (DPP-4) inhibitors are associated with an overall 75% increase in risk of inflammatory bowel disease.’
study led by Laurent Azoulay at McGill University assessed whether the use of
DPP-4 inhibitors is associated with inflammatory bowel disease
in patients with type 2 diabetes.
team analyzed data from the UK's Clinical Practice Research Database involving
141,170 patients aged 18 years and above. The patients were on antidiabetic
drugs between 2007 and 2016. The study excluded patients treated with insulin
and those with a history of inflammatory bowel disease or similar digestive
disorders. Patients' age, body mass index (BMI),
smoking status, alcohol-related disorders and complication of diabetes were
taken into account. The study participants were monitored for an average of
three and a half years. The research team found that during the monitoring
period, 208 new cases of inflammatory bowel disease
were recorded with an
incidence rate of 37.7 per 100,000 person years.
The use of
DPP-4 inhibitors was associated with an increased risk of inflammatory bowel
disease by 75% (53.4 cases per 100,000 person years) compared with the use of
other antidiabetic drugs (34.5 cases per 100,000 person years).
between DPP-4 inhibitor use and inflammatory bowel disease increased with
longer durations of DPP-4, reaching a peak after three to four years and
decreasing after more than four years of use.
team said that this is an observational study and no firm conclusions can be
drawn on the cause and effect. The limitation of the
study is the possible misclassification of drugs or cases. The other limitation
is after adjusting for several risk factors; the research team could not rule
out the possibility that other unmeasured factors may have influenced the
results. Nevertheless, this is the first population-based study to analyze the
use of DPP-4 inhibitors association with an increased risk of inflammatory
team concluded that "although our findings need to be replicated, physicians
should be aware of this possible association and perhaps refrain from
prescribing DPP-4 inhibitors for people at high risk for inflammatory bowel
disease, such as those with a family history of the disease or with known
Inflammatory Bowel Disease?
bowel disease is a term for Crohn's
and ulcerative colitis that is characterized by chronic
inflammation of the gastrointestinal tract. Inflammatory bowel disease causes
abdominal discomfort and bloating.
shown that inflammatory bowel disease along with diabetes can complicate
treatment for both. Certain drugs like steroids
which are used to treat symptoms like
diarrhea, stomach ache and inflammation may raise blood glucose levels. For
diabetes patients with inflammatory bowel disease, drugs like metformin can
cause side effects like diarrhea, nausea and abdominal pain. For patients with
inflammatory bowel disease, it is advisable to consult a doctor for
antidiabetic medications that do not raise blood glucose levels.
- Azoulay L, Bitton A, Renoux C, Yun Yu O H, Yin H, Douros A, Abrahami D. "Dipeptidyl peptidase-4 inhibitors and incidence of inflammatory bowel disease among patients with type 2 diabetes: population based cohort study", The BMJ (2018). doi: (https://doi.org/10.1136/bmj.k872)