Oral administration of US FDA approved DPP-4 inhibitors, such as Saxagliptin, Vildagliptin, Anagliptin, etc., prolongs the half-lives and thus the action of GLP-1 and GIP, which in turn improves glycemic control with minimal risk of hypoglycemia (Havale and Pal, 2009)
If a step provokes strong GI symptoms, the documented approach is to hold at the current dose (or step back down) rather than push forward on the calendar
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Across multiple meta-analyses, the most consistent finding is improved postprandial glucose control
Step 3: NICE Assessment (For NHS Use) If MHRA approval is granted, the medicine may then be assessed by NICE to determine: Cost-effectiveness Eligible patient groups Prescribing criteria Whether the NHS funds it This stage mainly affects NHS availability, but private prescribing decisions may differ depending on the product licence