Treatment incretin mimetics

Nauck MA. Glucagon-like peptide 1 (GLP-1) and incretin mimetics for the treatment of diabetes. Pract Diabetes Int 2005 22 171-9. 

Gryskiewicz K, Coleman CL Exenatide. A novel incretin mimetic hormone for the treatment of type 2 diabetes. Formulary 2005 40 86-90. 

In this chapter, a suggestion will be developed on how incretin mimetics and DPP-4 inhibitors will fit into established treatment algorithms for glycemic control in patients with type 2 diabetes (see Fig. 6A). 

The novel classes of antidiabetic agents, incretin mimetics and DPP-4 inhibitors, may hold two additional promises A reduction in cardiovascular complications typically associated with type 2 diabetes [188] and the metabohc syndrome, and a positive influence on the natural history of type 2 diabetes, which with current treatment options is characterized by a steady loss of P-cell function [189,190], which in turn determines a rather short durability of successful glycemic control with any choice of antidiabetic agents [191,192]. 

Cardiac Effects of GLP-1 Consequences of the Treatment with Incretin Mimetics and DPP-4 Inhibitors... 

With incretin mimetics and DPP-4 inhibitors, two novel classes of antidiabetic agents have been developed and are in the course of being approved for the treatment of patients with type 2 diabetes, which will certainly broaden the armamentarium of anti-hyperglycemic therapy. This is valid based on their properties that have already been characterized in clinical trials. Some additional properties need to be explored in future studies, but hold the promise to make a substantial contribution to changing the course of type 2 diabetes, from the prevention of the transition between the prediabetic state to manifest diabetes, to improved and more durable metabolic control with less unwanted side effects and the prevention of diabetic complications. 

Gastrointestinal The most frequent adverse reactions reported with incretin mimetics are gastrointestinal symptoms. These include nausea, vomiting, and diarrhea, which occur in 10-15% of patients, are dose-related, and tend to abate during the first few weeks of treatment [54 ]. 

Neiimiller JJ, Campbell RK. Liraglutide a once daily incretin mimetic for the treatment of type 2 diabetes mellitus. Ann Pharmacother 2009 43 1433-44. 

Fig. 7.2 The incretin system. Relationship between the physiological effects of GLP-l and GIP on insulin secretion and the action of targets implied in T2DM treatment. GLP-l and GIP are released from enteroendocrine cells after nutrient ingestion to stimulate insulin secretion. However, their activity is reduced because of the cleavage of DPP-IV at the second residue of GLP-l and GIP. Two alternatives to avoid the cleavage are administration of incretin mimetics ot DPP-IV inhibitors...

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