ABSTRACT
Most diabetes is polygenic in etiology, with (type 1 diabetes, T1DM) or without (type 2 diabetes, T2DM) an autoimmune basis. Genetic counseling for diabetes generally focuses on providing empiric risk information based on family history and/or the effects of maternal hyperglycemia on pregnancy outcome. An estimated one to five percent of diabetes is monogenic in nature, e.g., maturity onset diabetes of the young (MODY), with molecular testing and etiology-based treatment available. However, recent studies show that most monogenic diabetes is misdiagnosed as T1DM or T2DM. While efforts are underway to increase the rate of diagnosis in the diabetes clinic, genetic counselors and clinical geneticists are in a prime position to identify monogenic cases through targeted questions during a family history combined with working in conjunction with diabetes professionals to diagnose and assure proper treatment and familial risk assessment for individuals with monogenic diabetes.
ABSTRACT
INTRODUCTION: Vildagliptin is a dipeptidyl peptidase-4 inhibitor targeting the incretin system to improve glycemic control in type 2 diabetes. AREAS COVERED: This review focuses on the pharmacokinetics, drug interactions and use of oral vildagliptin in special populations. Clinical efficacy and vildagliptin's role in the spectrum of therapeutics available are briefly addressed. EXPERT OPINION: Vildagliptin is an effective and well-tolerated oral dipeptidyl peptidase-4 inhibitor. It is dosed orally and can be used safely as monotherapy or in combination with other oral anti-hyperglycemic agents and insulin. It is rapidly absorbed and can be taken without regard to food. It is metabolized by hydrolysis and renally cleared. It has low potential for drug interactions and is well tolerated in elderly patients. Body mass index and gender have no significant pharmacokinetic impact. There is no significant interaction with CYP enzymes. There is a low risk for hypoglycemia and weight gain. Dose adjustment is recommended for renal impairment. Prescribing vildagliptin in the setting of liver dysfunction is not recommended, although pharmacokinetics is minimally (if at all) affected. A variety of patients with type 2 diabetes may benefit from treatment with vildagliptin. Therapy should be individualized but the paucity of data in populations with advanced renal failure and hepatic dysfunction may limit the use in these patients.
