Open Access
Review
09 October 2025Sitagliptin in Type 2 Diabetes Mellitus and Cardiovascular Disease: A Public Health and Health Equity Perspective
Type 2 diabetes mellitus and cardiovascular disease are interrelated conditions that disproportionately affect underserved populations, with compounded risk in communities facing systemic barriers to care. This review synthesizes clinical trial evidence, preclinical research, and public health perspectives to evaluate sitagliptin’s pharmacologic profile, safety, and potential vascular effects, particularly in resource-limited settings. Sitagliptin, the first FDA-approved oral DPP-4 inhibitor, demonstrates weight neutrality, minimal hypoglycemia risk, and renal dosing flexibility. Large cardiovascular outcomes trials confirm cardiovascular neutrality, while preclinical and animal studies suggest possible microvascular benefits. Despite superior cardiovascular outcomes with newer agents like GLP-1 receptor agonists and SGLT2 inhibitors, sitagliptin remains a practical option for patients who cannot access or tolerate these therapies, supported by oral dosing, low side-effect burden, and anticipated generic availability in the US. Its continued value is evident in U.S. safety-net systems such as federally qualified health centers (FQHCs), and globally in low- and middle-income countries where newer drugs remain unaffordable. Achieving meaningful public health impact will require pairing pharmacologic safety with structural access improvements, including expanded insurance coverage, protection of safety-net drug pricing programs, culturally tailored interventions, and inclusive research practices. Sitagliptin illustrates a broader principle in chronic disease care: even safe therapies cannot close disparities until equitable access.
Open Access
Communication
31 October 2025Impact of SGLT2 Inhibitors on PA Pressures in D-TGA after Atrial Switch Operations
Heart failure (HF) is the leading cause of mortality in adults with congenital heart disease (ACHD), including patients with systemic right ventricles, such as those with dextro-transposition of the great arteries with an atrial switch (DTGA-AS). With more ACHD patients surviving well into adulthood, there is an increase in advanced heart failure (HF) and pulmonary hypertension (PH), many of whom are being treated with SGLT2-inhibitors (SGLT2-i). However, there is a paucity of data supporting SGLT2-i inhibitor use in the ACHD population and on how they may impact pulmonary artery pressures (PAP). This single center retrospective study aimed to evaluate the impact of SGLT2-i on (PAP) in patients with DTGA-AS. Six patients were studied, all male (mean age 41 [range 38–52] years), with a mean systemic right ventricular ejection fraction of 27% (range 22–32%), with an implanted hemodynamic CardioMEMs monitor data were recorded one month prior to medication start and six months afterwards. Half of the patients had normal PAP, and the addition of SGLT2i did not result in a significant change in PAP in all patients. However, half of the patients demonstrated a trend towards improvement. In conclusion, in this study with a small sample size of DTGA-AS patients, there was no significant reduction in PAP.