DEAR DR. ROACH: I have been taking 20 mg of teneligliptin with metformin to control my Type 2 diabetes. It has been much better than taking 5 mg of glipizide or other combinations with metformin, and there have been no side effects. Teneligliptin is prescribed in most countries, including Japan and Europe. Why it is not yet approved by the Food and Drug Administration for use in the United States? — J.M.
ANSWER: Glipizide is among the earliest oral agents available for the treatment of Type 2 diabetes. It is a sulfonylurea and works by forcing the pancreas to excrete more insulin. Since the underlying problem in Type 2 diabetes is resistance to insulin (not a lack of insulin), sulfonylureas are not an ideal choice and often fail to maintain blood sugar after several years of use.
There are many additional choices now. Teneligliptin is in the class of dipeptidyl peptidase 4 (DPP-4) inhibitors, which increase insulin secretion, delay gastric emptying (favoring weight loss and slower sugar absorption), and reduce the anti-insulin hormone glucagon. DPP-4 inhibitors are most commonly used in combination with metformin (which prevents the liver from making extra sugar), if metformin alone is inadequate.
There are four DPP-4 inhibitors available in the U.S. and a fifth one in Canada. All are available as combination pills with metformin. Teneligliptin is very inexpensive, and it has relatively few side effects. But otherwise, there does not seem to be a significant improvement in any outcome with teneligliptin, compared to sitagliptin or any of the other available DPP-4 inhibitors.
While I am glad you haven’t had side effects, no drug is free from the possibility of side effects. DPP-4 inhibitors have been associated with a small risk of pancreatitis, joint pain and allergic skin reactions.
I have no insight as to why the FDA has not yet approved teneligliptin for use in the U.S. But trials are underway, and there are similar choices available.
DEAR DR. ROACH: My mother had chronic nervous anxiety for years and took Xanax all the time. She passed away at 84. Now I have the same condition. I take buspirone for it. It helps, but does not cure it completely. Is the condition inherited through family? — E.J.
ANSWER: There definitely is an increased risk of developing both anxiety (we use the term “generalized anxiety disorder” now for what I think you are describing) and depression in people who have a family history. At least two genes have been identified. However, early childhood trauma can predispose people to anxious disorders as well. The condition may develop in early adulthood or later on in life, but can honestly happen at any time.
I do not treat anxiety disorders with benzodiazepine drugs (like Xanax, Valium or Klonopin) in the long-term, although I sometimes use them for a week or two while other treatments are starting. There is too much evidence of neurological harm from long-term use of these drugs, even though some people do very well for decades.
I tend to prescribe selective serotonin reuptake inhibitor (SSRI) medications like sertraline or citalopram in people who need medication. Buspirone is a very safe medicine that, in my experience, is modestly effective. Psychotherapy and cognitive behavioral therapy are other good alternatives. Many people do best with a combined approach.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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