Weight neutrality with the DPP-4 inhibitor, vildagliptin: mechanistic basis and clinical experience.

42 – 50 In a head-to-head randomized clinical trial in patients with relatively low baseline glycemic values (mean HbA 1C 7.3%, fasting plasma glucose [FPG] 9.2 mmol/L [165 mg/dL]), patients inadequately controlled on metformin who were randomized to vildagliptin 50 mg bid were weight stable at 52 weeks (−0.2 kg), which was highly significant compared with the weight gain seen in the comparator group receiving glimepiride ≤6 mg daily (between-group difference −1.8 kg, P < 0.001). 41 This difference presumably stems in part from the glucose-dependent “fail-safe” system that prevents even elevated incretin levels from overstimulating insulin secretion in the absence of elevated or rising glucose levels.

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