Dipeptidyl peptidase-4 inhibitors and joint pain: A retrospective cohort study of older veterans with type 2 diabetes mellitus

Pragya Rai, Nilanjana Dwibedi, Mazhgan Rowneki, Drew A. Helmer, Usha Sambamoorthi

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


BACKGROUND: In recent years, dipeptidyl peptidase (DPP)-4 inhibitors have been added to the diabetes treatment algorithm. Few published studies have shown that the use of DPP-4 inhibitors is associated with joint pain. To our knowledge, no population-based studies in the United States have studied this association. OBJECTIVE: To evaluate the association between a new prescription of DPP-4 inhibitors and joint pain within 1 year among older veterans with diabetes. METHODS: This was a retrospective cohort study of older veterans (aged ≥66 years) who were dually enrolled in Medicare and the Veterans Health Administration (VHA; N = 134,488). Data were derived from linked Medicare claims and VHA electronic health records from 2008 to 2010. Diabetes during the baseline and joint pain during the follow-up period were identified with International Classification of Diseases, Ninth Revision codes. Filled prescriptions for DPP-4 inhibitors during the baseline period were identified from Medicare Part D and VHA pharmacy records. The adjusted associations between DPP-4 inhibitors and joint pain were examined with logistic regressions. RESULTS: Approximately 8.4% of the 134,488 study patients received at least 1 prescription for DPP-4 inhibitors and 11.7% were diagnosed with joint pain during the follow-up period. An unadjusted analysis showed significant differences in joint pain by DPP-4 inhibitor status (12.9% among users vs 11.6% among nonusers; P <.0001). In a fully adjusted model, having a DPP-4 inhibitor prescription had higher odds of joint pain (adjusted odds ratio, 1.17; 95% confidence interval, 1.10-1.24) compared with no prescription for a DPP-4 inhibitor. CONCLUSION: In a cohort of older veterans who did not have documented joint pain at baseline, a prescription for DPP-4 inhibitors was significantly associated with a newly documented joint pain.

Original languageEnglish
Pages (from-to)223-231
Number of pages9
JournalAmerican Health and Drug Benefits
Issue number5
StatePublished - Sep 2019


  • Dipeptidyl peptidase-4 inhibitors
  • Hemoglobin A
  • Joint pain
  • Older veterans
  • Type 2 diabetes mellitus
  • Veterans Health Administration


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