In recent years, the prevalence of diabetes in China has continued to rise, but the control rate is still at a low level, and more effective prevention and control measures and optimized treatment options are urgently needed. In this context, the new generation of DPP-4 inhibitor senpaliptin has been approved for marketing in China, providing a new option for the treatment of T2DM. In order to have a deeper understanding of the current status of diabetes mellitus in China, as well as the important value of DPP-4 inhibitors in hypoglycemic therapy, especially the drug characteristics and hypoglycemic efficacy of the new generation of DPP-4 inhibitor senpaglitin, we specially invited Professor Su Qing from Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine to conduct an in-depth interview to share his professional insights and valuable experience.

Diabetes mellitus is one of the major diseases that threaten the health of our people, first of all, please talk about the current incidence and management of diabetes in China?
Professor Su Qing: In the past 20 years, China has done a lot of research on the epidemiology of diabetes, and the results have been published in top international journals, which is also an important field of international academic research on diabetes in the world. The latest epidemiological survey was conducted by the National Center for Chronic and Noncommunicable Diseases (NCDC) and the Chinese Center for Disease Control and Prevention from 2018 to 2019, covering more than 170,000 people, and the results showed that the prevalence of diabetes in adults in China was 12.4% according to the diagnostic criteria of the American Diabetes Association (ADA) [1].
The main reasons for the increase in the prevalence of diabetes in China are: the acceleration of urbanization, the aging of the population, and the increasing prominence of overweight and obesity, in the final analysis, the huge change in people's lifestyle. In addition, the problem of environmental pollution cannot be ignored, and environmental pollution is related to the increase in the prevalence of diabetes. The accelerated pace of life in modern society, the increasing stress of people, and the frequent occurrence of psychological and health problems such as insomnia and mental illness have all contributed to the increase in the prevalence of diabetes. Although the sharp increase in the prevalence and number of people with diabetes in China at the beginning of this century has been basically curbed, the prevalence and number of people with diabetes are still growing slowly.
In terms of overall diabetes control, although China has achieved some success in controlling the rapid growth of diabetes, there is still a gap between China and Western developed countries in terms of key indicators. At present, the awareness rate of diabetes in China is about 36%, the treatment rate is less than one-third, and the control rate is only about 50% [2]. In the past decade, the improvement of these indicators has not been significant, and there is an urgent need for the whole society to raise awareness and attention to diabetes. It is worth noting that the Chinese government has listed diabetes as one of the four major chronic diseases and issued relevant policies to guide it. We believe that through the joint efforts of the whole society, we can not only effectively control the prevalence of diabetes, but also significantly improve key indicators such as awareness, treatment and control rates.
"International Diabetes"
In the field of diabetes treatment, hypoglycemic drugs have been emerging in recent years, providing patients with more choices. As one of the important drugs, DPP-4 inhibitors occupy an important position in clinical application. So, what do you think of the value of DPP-4 inhibitors in glucose-lowering therapy?
Prof. Qing Su: DPP-4 inhibitors, as a new hypoglycemic drug that appeared earlier, have been on the market in China for 15 years since 2010 and are currently widely used nationwide. It has three main characteristics: (1) Significant efficacy: DPP-4 inhibitors are effective hypoglycemic drugs, which can usually reduce glycosylated hemoglobin (HbA1c) by 0.4%~0.9% after removing the placebo effect[2]. (2) High safety: DPP-4 inhibitors have a high safety profile, do not increase the risk of hypoglycemia, have no effect on body weight, and will not cause patients to have a psychological burden due to weight changes; In addition, compared with drugs such as metformin and GLP-1RA, its gastrointestinal reactions are milder, more easily tolerated by patients, and generally do not increase the risk of urinary tract infection, and are also relatively safe in cardiovascular aspects. (3) Easy to use: DPP-4 inhibitors are usually fixed doses, and patients only need to take one tablet per day (except for biweekly preparations), without the need for titration process or multiple doses, the drug cost is relatively low, and the patient compliance is better.
After the advent of DPP-4 inhibitors, domestic and foreign guidelines and many expert consensuses have highly affirmed them. The 2025 guidelines of the American ADA [3] and the 2024 guidelines of the Chinese Society of Diabetes (CDS) [2] both have high recommendations. DPP-4 inhibitors are an important choice when monotherapy is not up to standard in diabetic patients and dual therapy is initiated. In special groups such as the elderly, its treatment status has been further improved, and DPP-4 inhibitors and metformin are both first-line treatment options in the Guidelines for the Diagnosis and Treatment of Diabetes Mellitus in the Chinese Geriatrics (2024 Edition) [4]. In addition, DPP-4 inhibitors are widely used in clinical practice, which fully demonstrates that this class of drugs is well recognized by doctors and patients.
"International Diabetes Mellitus"
Senpaglitin, a new generation of DPP-4 inhibitor independently developed in China, was approved for marketing in December 2024, bringing a new option for the treatment of patients with T2DM. Could you please introduce the outstanding features of this drug, especially how it performs in hypoglycemic therapy?
Prof. Qing Su: Senpelliptin, as a new member of the DPP-4 inhibitor family, is an innovative drug with a different chemical structure from the marketed DPP-4 inhibitors. In a previous phase I, head-to-head clinical study, sentagliptin 50 mg inhibited DPP-4 was comparable to sitagliptin 100 mg [5-6]. It is worth mentioning that due to the excellent data shown in the head-to-head phase I clinical trial, senpaliptin was exempted from the phase II clinical trial and directly entered the phase III clinical trial, creating a precedent for DPP-4 inhibitor clinical trials to "enter III without II".
In the phase III clinical trial, semblagliptin monotherapy for 24 weeks in T2DM patients reduced HbA1c by 1.08%, removing the placebo effect, and semblagliptin alone reduced HbA1c by 0.72%, which was statistically significant and clinically significant (see Figure 1). At 24 weeks of sengelliptin monotherapy, the proportion of patients with HbA1c < 7 percent was nearly 3.5 times higher than that of the placebo group, and the proportion of patients with HbA1c < 6.5 percent was nearly 10 times higher than that of the placebo group (see Figure 2) [7].

Figure 1. Sengliliptin monotherapy in patients with T2DM HbA1c Picture picture

Figure 2. Sengliliptin monotherapy in patients with T2DM HbA1c attainment rate

In addition, the combination of sengliptin and metformin has also shown good results. In patients with T2DM who failed metformin treatment, the combination of senrigliptin and placebo resulted in a statistically significant decrease in HbA1c by 0.79% (Fig. 3). The proportion of patients with HbA1c < 7 percent at 24 weeks with senlagliptin plus metformin was 3.5 times higher than that in the placebo group, and the proportion of patients with HbA1c < 6.5 percent at 24 weeks with senrigliptin plus metformin was 5.5 times higher than that in the placebo group (see Figure 4) [8].

Figure 3. Picture of the change from baseline in HbA1c in patients with T2DM treated with sengliptin in combination with metformin

Figure 4. Senlagliptin in combination with metformin in the treatment of HbA1c in patients with T2DM

In addition to its excellent hypoglycemic effect, sengliptin also has a good safety profile. The incidence of adverse reactions in the senlagliptin treatment group was similar to that in the placebo group; Neither monotherapy nor in combination with metformin has resulted in any hypoglycemic events [7-8].
Conclusion As one of the major chronic diseases in China,
the prevalence of diabetes mellitus has continued to rise in recent years, and the prevention and control situation has become increasingly severe. Due to its remarkable efficacy, good safety and ease of use, DPP-4 inhibitors have been unanimously recommended by domestic and foreign guidelines as important drugs for hypoglycemic therapy, and are widely used in clinical practice. As a new DPP-4 inhibitor independently developed in China, sengliptin has achieved a strong inhibitory effect on DPP-4 enzyme by virtue of its innovative chemical structure. Clinical studies have shown that senagliptin, whether monotherapy or in combination with metformin, can significantly reduce the HbA1c level and improve the blood glucose compliance rate in patients, and is safe and well tolerated, providing a new option for optimizing blood glucose management in patients with T2DM and opening a new chapter in DPP-4 inhibitor therapy.