Incretin-based therapies

Med Clin North Am. 2015 Jan;99(1):107-29. doi: 10.1016/j.mcna.2014.08.013. Epub 2014 Oct 18.

Abstract

Incretin-based therapies are steadily gaining clinical popularity, with many more products in the developmental pipeline. Current treatment recommendations incorporate GLP-1 RAs and DPP-4 inhibitors as important agents for consideration in the treatment of T2DM owing to their low hypoglycemia risk, ability to address postprandial hyperglycemia (DPP-4 inhibitors and short-acting GLP-1 RAs), and potential for weight reduction (GLP-1 RAs). These properties may likewise prove advantageous in older adults in whom hypoglycemia is particularly undesirable, although older adults may be more prone to the nausea and vomiting associated with GLP-1 RA therapy. Other safety issues for incretin-based therapies, such as pancreatitis, C-cell hyperplasia, and renal failure, should be considered when choosing an appropriate patient to receive such therapies. Ongoing CV outcome studies will further inform the health care community regarding the CV safety of incretin-based therapies. The availability of both short-acting and long-acting GLP-1 RAs currently allows practitioners to consider individualized blood glucose trends and therapeutic needs when choosing an optimal agent.

Keywords: DPP-4 inhibitors; Dipeptidyl peptidase 4; GLP-1 receptor agonists; Glucagon-like peptide 1; Incretin effect; Incretin mimetics; Pharmacotherapy.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / metabolism
  • Dipeptidyl-Peptidase IV Inhibitors / pharmacology*
  • Drug Monitoring
  • Glucagon-Like Peptide-1 Receptor
  • Humans
  • Hypoglycemia* / chemically induced
  • Hypoglycemia* / prevention & control
  • Hypoglycemic Agents / pharmacology
  • Incretins / pharmacology*
  • Insulin / metabolism
  • Insulin Secretion
  • Receptors, Glucagon / agonists*
  • Treatment Outcome
  • Weight Loss / drug effects*

Substances

  • Dipeptidyl-Peptidase IV Inhibitors
  • GLP1R protein, human
  • Glucagon-Like Peptide-1 Receptor
  • Hypoglycemic Agents
  • Incretins
  • Insulin
  • Receptors, Glucagon