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Nihon Rinsho. 2013 Mar;71(3):555-62.

[Significance of combination therapy with an insulin sensitizer and a DPP-4(dipeptidyl peptidase-4) inhibitor].

[Article in Japanese]

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Department of Metabolic Medicine, Osaka University Graduate School of Medicine.


Type 2 diabetes mellitus is characterized by insulin resistance in peripheral tissues and relative impairment in insulin secretion from pancreatic beta cell. Insulin sensitizers such as metformin and pioglitazone reduce peripheral insulin resistance, whereas dipeptidyl peptidase-4(DPP-4) inhibitors augment postprandial insulin secretion and inhibit glucagon secretion. Combination therapy with an insulin sensitizer and a DPP-4 inhibitor provides substantial and additive glycemic improvement because of the complementary mechanisms of action of these agents. In addition, combination therapy with these agents is an attractive from the perspective of low incidence of hypoglycemia, beta cell preservation, augmentation of the incretin effect, and anti-atherogenic action.

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