Introduction

Tenetin-D is a fixed-dose oral antidiabetic combination containing Teneligliptin 20 mg (a DPP-4 inhibitor) and Dapagliflozin 10 mg (an SGLT2 inhibitor).
It is used for Type 2 Diabetes Mellitus (T2DM) in patients who do not achieve adequate glycemic control with single therapy, diet, and lifestyle modifications.

🔹 Indications

Management of Type 2 Diabetes Mellitus (T2DM).
As an add-on therapy in patients inadequately controlled on diet, exercise, or monotherapy.
May provide additional benefits in weight reduction and cardio-renal protection (dapagliflozin component).

🔹 Dosage

Adult dose: 1 tablet (Teneligliptin 20 mg + Dapagliflozin 10 mg) once daily, with or without food.
Adjustment: Dose adjustments usually not required in mild renal or hepatic impairment, but contraindicated in severe cases.
Always taken as per physician’s prescription.

🔹 Mechanism of Action (MoA)

Teneligliptin:
- Inhibits DPP-4 enzyme → increases incretin hormones (GLP-1 & GIP).
- Enhances glucose-dependent insulin secretion, reduces glucagon release.
- Improves postprandial and fasting blood glucose.
Dapagliflozin:
- Selective SGLT2 inhibitor in the renal proximal tubules.
- Prevents reabsorption of glucose in kidneys → increases urinary glucose excretion → lowers blood sugar independently of insulin.

✅ Dual action: One insulin-dependent (Teneligliptin) + one insulin-independent (Dapagliflozin).

🔹 Pharmacology

1. Absorption

Teneligliptin: Rapidly absorbed, peak plasma concentration in ~1–2 hrs, bioavailability ~90%.
Dapagliflozin: Peak plasma levels in ~2 hrs, bioavailability ~78%.

2. Distribution

Teneligliptin: Plasma protein binding ~60–70%.
Dapagliflozin: Plasma protein binding ~90%.

3. Metabolism

Teneligliptin: Metabolized mainly by CYP3A4 and FMO3.
Dapagliflozin: Metabolized primarily via UGT1A9 to inactive metabolite.

4. Excretion

Teneligliptin: ~45% via urine, ~55% via feces.
Dapagliflozin: Excreted mostly in urine as metabolites.

🔹 Precautions

Renal function monitoring (dapagliflozin can reduce renal threshold for glucose).
Risk of genital mycotic & urinary tract infections (dapagliflozin).
Monitor for hypoglycemia when combined with insulin or sulfonylureas.
Risk of volume depletion & hypotension due to osmotic diuresis.
Rare cases of pancreatitis (DPP-4 inhibitors).
Elderly patients: Use cautiously due to renal and dehydration risks.