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News
A large claims-based study of ~170,000 adults with type 2 diabetes found that alogliptin was associated with the lowest risk of kidney disease among four DPP-4 inhibitors, while linagliptin had the highest. The differences were statistically significant but modest, and researchers caution the findings are preliminary. Still, the data could serve as a useful "tiebreaker" for clinicians choosing between these agents.
For patients with type 2 diabetes (T2D) who can't use GLP-1 receptor agonists or SGLT2 inhibitors, DPP-4 inhibitors remain a common go-to — but a new study suggests the choice of which one matters more than previously thought. Analyzing claims data from roughly 170,000 adults with T2D and moderate cardiovascular risk, researchers found that alogliptin was associated with the lowest risk of kidney disease progression, while linagliptin carried the highest risk among the four agents studied.
The findings were unexpected — researchers initially anticipated no meaningful differences within the class, consistent with earlier cardiovascular outcome data. Alogliptin's edge was particularly surprising given that it's the least commonly prescribed DPP-4 inhibitor in the US. Experts caution that the absolute differences were small and that the study lacked key lab data (like eGFR and albuminuria), making the results preliminary.
By the Numbers:
Why it matters: When GLP-1 or SGLT2 agents aren't an option, clinicians now have early evidence to favor alogliptin or saxagliptin — and potentially avoid linagliptin — when kidney protection is a priority for T2D patients.
