Sudan Med J 2010:46(2) 65 Review Article Advances in pharmacotherapy of Type 2 diabetes (Part-3: The gliptins) Tarik A Elhadd, MD FRCP*, Sujoy Ghosh, MD MRCP**, Andrew Collier, MD FRCPE***, Abu baker Elameen Ahmed, MD FRCP **** Department of Medicine, UMST, Khartoum Sudan* AMRI Institute of Diabetes and Hormonal Disorders Calcutta, India** Department of Medicine & Diabetes Centre, Ayr Hospital, Scotland, UK*** Diabetes Centre, Victoria Hospital, Blackpool, UK**** اﻟﺴﻜﺮي ﻣﺮض ﻋﻼج ﻓﻲ اﻟﺘﻄﻮرات أﺣﺪث اﻟﺜﺎﻧﻲ اﻟﻨﻤﻂ ﻣﻦ) اﻟﺜﺎﻟﺚ اﻟﺠﺰء( د. اﻟﻬﺪ اﻟﻜﺮﻳﻢ ﻋﺒﺪ ﻃﺎرق د. ﻗﻮش ﺳﻮﺟﻮي د. آﻮﻟﻴﻴﺮ أﻧﺪرو د. أﺣﻤﺪ اﻷﻣﻴﻦ ﺑﻜﺮ أﺑﻮ " اﻟﺼﻤﺎء اﻟﻐﺪد و اﻟﺴﻜﺮي إﺳﺘﺸﺎري/ ﺑﺮﻳﻄﺎﻧﻴﺎ" ﺧ إﻳﺠﺎﺑﻴﺎ ﺗﻄﻮرا ﺷﻬﺪ ﻗﺪ اﻟﺜﺎﻧﻲ اﻟﻨﻤﻂ ﻣﻦ اﻟﺴﻜﺮي ﻣﺮض ﻋﻼج أن ﻣﺴﺘﺸـﻔﻴﺎت ﻣﻦ ﻋﻘﺎﻗﻴﺮ وﻇﻬﻮر ﻟﻠﻤﻴﻼد اﻟﺜﺎﻧﻴﺔ اﻷﻟﻔﻴﺔ ﻣﻦ اﻷول اﻟﻌﻘﺪ ﻼل" اﻟﺠﻠﺒﺘﻴﻦ" وهﻲ ﻟﻬﺮﻣﻮن اﻟﻤﺒﻄﻠﺔ اﻟﻤﺎدة إﻧﺰﻳﻢ ﻋﻤﻞ ﺗﺒﻄﻞ اﻟﺘﻲ اﻟﻤﻮاد ﺗﺜﺒﻴﻂ إﻟﻲ ﺗﺆدي أدوﻳﺔ" اﻷﻧﻜﺮﺗﻴﻦ" اﻟﺴﻜﺮي ﻣﺮﺿﻲ ﻋﻼج ﺣﻴﺚ ﻣﻦ وآﻴﻔﻴﻪ ﻧﻮﻋﻴﻪ ﻧﻘﻠﻪ إﻟﻲ ﺗﺆدي رﺑﻤﺎ. ﻓﻲ أﺟﺮﻳﺖ اﻟﺘﻲ اﻷﺑﺤﺎث أوﺿﺤﺖ اﻟﻌﻘﺎﻗﻴﺮ ﻣﻊ ﺗﻌﻄﻲ ﺣﻴﻦ ﺟﺪواهﺎ وﻻﺳﻴﻤﺎ اﻟﻤﺮﺿﻲ ﻣﺘﻨﺎول ﻓﻲ اﺻﺒﺤﺖ اﻟﺘﻲ اﻟﻌﻘﺎﻗﻴﺮ هﺬﻩ ﻓﻌﺎﻟﻴﺔ ﻣﺪي اﻷﺧﻴﺮة اﻟﺴﻨﻮات ﺗﺨﺘﻔﻲ اﻟﺘﻲ اﻟﺸﻬﻴﻪ وﺿﻌﻒ ﺑﺎﻟﻐﻴﺜﺎن اﻟﺸﻌﻮر ﺑﻌﺾ ﺳﻮي ﺑﺎل ذات ﺟﺎﻧﺒﻴﺔ اﻋﺮاض وﺟﻮد اﻟﺒﺤﻮث هﺬﻩ ﺗﺜﺒﺖ وﻟﻢ اﻟﻤﺘﻔﻮرﻣﻴﻦ و ﻳﻮرﻳﺰ اﻟﺴﻠﻔﻮﻧﻴﻞ ﻓﺌﺔ ﻣﻦ اﻟﺘﻘﻠﻴﺪﻳﺔ ﺑﻤﺮ ﺗﺪرﻳﺠﻴﺎ اﻟﺰﻣﻦ ور. Summary Type 2 diabetes is witnessing major advances in pharmacotherapy. After a rather dormant period spanning the period from 1960s to the 1990’s following the discovery of the sulphonylurea and biguanide groups of drugs in the 1950’s, significant advances have been achieved in discovering new drugs. This has been possible because of the advances in biotechnology. In this part of the series of reviews we will be looking at the second group of the incretin-based therapies. These gliptins which include several agents, namely sitagliptin, vildagliptin and saxagliptin, with others still in development. The other group _____________________________________ Correspondent author Dr AE Ahmed MD FRCP Consultant Physician Department of Medicine & Diabetes Centre Victoria Hospital, Blackpool of the incretin-based agents, the incretin mimetics have been discussed in more details in the previous issue of this journal. Keywords: Diabetes mellitus, incretin mimetics, gliptins, type 2 diabetes Dipeptidylpeptidase-4 Introduction In the previous articles, we have presented an overview of the conventional oral anti- hyperglycaemic agents, metformin, sulphonylurea, metiglinides, and thiazolidinediones, and their role in management of patients with type 2 diabetes (1) . In the preceding issue of this journal we have discussed the role of the incretin-mimetics (2) . In this article, we shall continue to discuss the mechanism of action, potential impact and the role of the other group of the incretin-based anti- hyperglycaemic therapies in management of patients with type 2 diabetes. This second