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Despite the loss of its insulinotropic effect, the GLP-1 products of DPP-4 catalysis exert other actions, such as suppression of hepatic glucose production and antioxidant activity in the cardiovascular system [14]
Some animal studies suggest the R-isomer may be more effective than the S-isomer at improving insulin sensitivity, but head-to-head clinical studies in humans comparing the two forms have not been conducted [1]
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Table 1 gives a summary of the clinical phase III studies with at least 52 weeks duration on the efficacy of DPP-4 inhibitors compared to sulfonylureas as add on therapy to metformin, respectively, in patients not reaching their glycaemic goals with a monotherapy of metformin
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Elevated homocysteine levels are associated with an increased risk of heart-related issues, making B12 a crucial element in cardiovascular health maintenance
