Dr. Alka Gandhi: Resolving the Case of Adverse Drug Event in Management of T2DM
CASE OVERVIEW
DPP-4 inhibitors are an established class of oral antidiabetic agents for the treatment of type 2 diabetes. The most widely used among them are Sitagliptin, Linagliptin, Vildagliptin, Saxagliptin, and Allogliptin. A 75-year old male, known case of diabetes and hypertension since 5 years, visited the OPD of Dr. Alka Gandhi for his uncontrolled blood sugars. His weight was 88 kg with BMI of 28 kg/m2. He reported no complaints and had no history of drug allergy. The patient was on premix insulin, 12 units before breakfast and 8 units before dinner along with metformin (500 mg), twice a day. He was also on Telmisartan (40 mg), Metaprolol (25 mg), and Amlodepin (5 mg) for his hypertension along with Atorvastatin (10 mg).
DIAGNOSIS & MANAGEMENT
His FBS was 189 mg/dl, PPBS was 225 mg/dl, and HbA1c 8.9 %. Patient was started on tablet Vildagliptin (50 mg twice a day) along with the above medications.
RESULTS
Patient came back after 15 days with FBS of 90, PPBS of 142 but complains of rash all over the body with itching and oozing since 10 days. Patient had visited dermatologist for the same. He was advised antibiotics and antihistaminics along with ointments for local application. However, there wasn’t much relief. As the gliptin was started recently, Dr. Gandhi suspected that the DPP4 inhibitor induced skin rash hence vildagliptin was stopped immediately.
TREATMENT
Itching improved and the rash withered after 7 days. This case highlights the skin reactions as an important and lesser known side effect of DPP4 inhibitor.
CONCLUSION
We suggest that in our patients development of allergic reaction of skin was due to gliptin alone. Although skin eruption due to gliptin is rare, it is a considerable complication. Despite its unknown mechanism, this reaction should be considered in patients using gliptin.
