Impact of Reduction in Pill Load Upon Use of a Once Weekly DPP-4 Inhibitor in 2 Cases of Type 2 Diabetes

Abstract

Introduction: DPP-4 inhibitors are an integral part of the treatment of type 2 diabetes mellitus in Kenya. Most diabetics suffer from a lack of adherence due to a high pill burden due to multiple co-morbidities and the stigma of dependence on medication. Trelagliptin is a unique DPP-4 inhibitor due to its long biological half-life making it acceptable to be taken as a once-a-week dose. It was first accepted for use in Japan in 2015 and only got into the Kenyan market about 3 years ago. Here we have examined the effects of introducing this molecule into the regimen of a diabetic with extremely poor adherence due to a busy schedule and another diabetic who had multiple co-morbidities and subsequently a high pill load – with the benefits of its use in each case over a period of 6 months of observation. Methods: These cases reported are the first of a 39-year-old female businessperson with a busy schedule and known to have mild hypothyroidism – yet always missing her medication. She was not confident in her consistency of medication uptake and always slacked in coming in for her tests because of the same. She is diagnosed to have diabetes with strong family history and thereafter she declined to add to her medication with daily metformin. She improved tremendously upon commencing trelaglyptin. The other is of an elderly woman who also had diabetes mellitus type 2, dyslipidemia, BPPV, and hypertension. She was unhappy about her results for diabetes and due to inconsistency in taking her medication but agreed to start on the trelaglyptin since it was once a week. Her outcomes were also very good from the same. Conclusion: The use of trelaglyptin with the patients in Kenya could potentially lead to reduced stigma and inertia toward commencing medication and improved adherence to medication regimens in diabetes.