Pharmacologic: enzyme inhibitors
Adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus; may be used as monotherapy or combination therapy with metformin and a thiazolidinedione and/or a sulfonylurea.
Inhibits the enzyme dipeptidyl peptidase-4 (DPP-4), which slows the inactivation of incretin hormones, resulting in increased levels of active incretin hormones. These hormones are released by the intestine throughout the day, and are involved in regulation of glucose homeostasis. Increased/prolonged incretin levels increase insulin release and decrease glucagon levels. Therapeutic Effects: Improved control of blood glucose.
Adverse Reactions/Side Effects
CNS: headache. GI: nausea, diarrhea. Resp: upper respiratory tract infection, nasopharyngitis. Misc: hypersensitivity reactions including anaphylaxis, angioedema, and exfoliative skin conditions (Stevens-Johnson syndrome), rash, urticaria.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor signs of hypersensitivity reactions (anaphylaxis, angioedema, Stevens-Johnson syndrome), including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) and skin reactions (rash, pruritius, urticaria, burning skin, exfoliation, swelling in the face). Notify physician immediately of these signs.
Be alert for signs of hypoglycemia, especially during and after exercise. Common neuromuscular signs include anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; difficulty in concentration; drowsiness; excessive hunger; headache; irritability; nervousness; tremor; weakness; unsteady gait. Report persistent or repeated episodes of hypoglycemia to the physician.
Monitor symptoms of upper respiratory tract infection and inflammation including cough, production of mucus, wheezing, chest discomfort, shortness of breath, fatigue, chills, and fever. Report severe or prolonged symptoms to the physician.
Assess blood pressure periodically (See Appendix F). A sudden or sustained increase in blood pressure (hypertension) may indicate problems in diabetes management and should be reported to the physician.
Implement aerobic exercise and endurance training programs to maintain optimal body weight, improve insulin sensitivity, and reduce the risk of macrovascular disease (heart attack, stroke) and microvascular problems (reduced blood flow to tissues and organs that causes poor wound healing, neuropathy, retinopathy, and nephropathy).
Encourage patient to monitor blood glucose before and after exercise and to adjust food intake to maintain normal glycemic levels.
Emphasize the importance of adhering to nutritional guidelines and the need for periodic assessment of glycemic control (serum glucose and glycosylated hemoglobin levels) throughout the management of diabetes mellitus.
Advise patient about symptoms of hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, polyuria; loss of appetite; unusual thirst). Drug dosages may need to be adjusted to prevent repeated episodes of hyperglycemia.
Instruct patient to report other troublesome side effects such as severe or prolonged headache or GI problems (nausea, diarrhea).