Incorporating incretin-based therapies into clinical practice for patients with type 2 diabetes

Adv Ther. 2014 Mar;31(3):289-317. doi: 10.1007/s12325-014-0100-5. Epub 2014 Feb 15.

Abstract

Background: Effective, evidence-based management of type 2 diabetes (T2D) requires the integration of the best available evidence with clinical experience and patient preferences.

Methods: Studies published from 2000 to 2012 evaluating glucagon-like peptide-1 receptor agonists (GLP-1RAs) or dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) were identified using PubMed. The author contextualized the study findings with his clinical experience.

Results: Incretin-based therapy targets multiple dysfunctional organs in T2D. Injectable GLP-1RAs provide substantial glycemic control and weight reduction; while oral DPP-4 inhibitors provide moderate glycemic control and weight neutrality. Both classes are effective, well tolerated, and associated with a low incidence of hypoglycemia when used alone or in combination with other antidiabetes agents. GLP-1RAs are associated with transient nausea and, like DPP-4 inhibitors, rare pancreatitis.

Conclusion: Data indicate and clinical experience confirms that incretins are well tolerated in appropriate patients and provide sustained glycemic control and weight loss or weight neutrality throughout T2D progression.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adamantane / analogs & derivatives
  • Adamantane / therapeutic use
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Dipeptides / therapeutic use
  • Dipeptidyl-Peptidase IV Inhibitors / therapeutic use*
  • Exenatide
  • Glucagon-Like Peptide 1 / analogs & derivatives
  • Glucagon-Like Peptide 1 / therapeutic use
  • Glucagon-Like Peptide-1 Receptor
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Linagliptin
  • Liraglutide
  • Peptides / therapeutic use
  • Piperidines / therapeutic use
  • Purines / therapeutic use
  • Pyrazines / therapeutic use
  • Quinazolines / therapeutic use
  • Receptors, Glucagon / agonists*
  • Sitagliptin Phosphate
  • Treatment Outcome
  • Triazoles / therapeutic use
  • Uracil / analogs & derivatives
  • Uracil / therapeutic use
  • Venoms / therapeutic use
  • Weight Loss

Substances

  • Dipeptides
  • Dipeptidyl-Peptidase IV Inhibitors
  • GLP1R protein, human
  • Glucagon-Like Peptide-1 Receptor
  • Hypoglycemic Agents
  • Peptides
  • Piperidines
  • Purines
  • Pyrazines
  • Quinazolines
  • Receptors, Glucagon
  • Triazoles
  • Venoms
  • Linagliptin
  • Uracil
  • Liraglutide
  • Glucagon-Like Peptide 1
  • saxagliptin
  • Exenatide
  • alogliptin
  • Adamantane
  • Sitagliptin Phosphate