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Diet-induced weight loss (WL) leads to increased hunger and reduced fullness feelings, increased ghrelin and reduced satiety peptides concentration (glucagon-like peptide-1 (GLP-1), cholecystokinin (CCK) and peptide YY (PYY))

Indications: Type 2 Diabetes Mellitus (monotherapy or add-on therapy) Especially useful in patients who cannot tolerate metformin or sulfonylureas Can be used in elderly and patients with mild renal impairment Approved Agents in India: Sitagliptin (Januvia) Vildagliptin (Galvus) Saxagliptin (Onglyza) Linagliptin (Trajenta) No renal dose adjustment needed Alogliptin (Nesina) Dosing: Once daily oral dosing Some agents require renal dose adjustment (except Linagliptin) Often combined with metformin or SGLT2 inhibitors Side Effects: Nasopharyngitis, headache GI upset (mild) Rare: Acute pancreatitis, severe joint pain, skin reactions Saxagliptin may slightly increase risk of heart failure in some patients Advantages Over Other Classes: Weight neutral Low risk of hypoglycemia Well tolerated in the elderly Convenient once-daily dosing Limitations: Modest HbA1c reduction (0.50.8%) Not effective in Type 1 Diabetes Less potent than GLP-1 analogs or SGLT2 inhibitors Conclusion: DPP-4 inhibitors are a safe, effective, and well-tolerated option for many patients with T2DM especially those needing an add-on to metformin or who can't tolerate injectables

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The gut microbiome is considered the most abundant pool of microorganisms, which release metabolic products that facilitate gut-brain signaling

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