Combined Dipeptidyl Peptidase 4 Inhibitor and α-Glucosidase Inhibitor Treatment in Postprandial Hypoglycemia

Broome et al present a case of novel use of combination treatment with a dipeptidyl peptidase 4 (DPP-4) inhibitor and an alpha-glucosidase inhibitor for idiopathic postprandial reactive, hypoglycemia (RH) that was refractory to lifestyle intervention and alpha-glucosidase inhibitor treatment alone. A 24-year-old Caucasian woman with a medical history significant for generalized anxiety disorder, major depressive disorder, borderline personality disorder, restrictive eating disorder, psychogenic non-epileptiform seizures, postural orthostatic tachycardia syndrome, and carcinoid tumor of the appendix (surgically removed with appendectomy) presented to the emergency department after experiencing 2 days of neck pain and frontal headache. It is therefore believed that alpha-glucosidase treatment blunts the insulin response to glucose directly by delaying glucose absorption and indirectly by reducing GIP secretion.