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Overview of glucagon-like peptide-1 analogs and dipeptidyl peptidase-4 inhibitors for type 2 diabetes Pratley REMedscape J Med 2008[Jul]; 10 (7): 171CONTEXT: Impairment of incretin activity is now recognized as integral to the metabolic derangement underlying type 2 diabetes. Glucoregulatory agents that target the incretin system have recently been developed, and the place of these drugs in the treatment of type 2 diabetes can be assessed based on a growing body of clinical data. EVIDENCE ACQUISITION: A PubMed search was conducted to identify clinical studies of incretin therapies in type 2 diabetes. Article reference lists were also searched for relevant information, and supplemental material such as conference abstracts, drug prescribing information, and treatment guidelines were included as appropriate. EVIDENCE SYNTHESIS: Two classes of therapies target the incretin system. The first, glucagon-like peptide-1 (GLP-1) agonists (exemplified by exenatide and liraglutide), have demonstrated considerable efficacy in clinical trials, reducing hemoglobin A1c (HbA1c) by up to 1.3%, decreasing fasting and postprandial glucose concentrations, reducing weight by approximately 3.0 kg, and improving cardiovascular risk factors. The second class, the dipeptidyl peptidase-4 inhibitors (such as sitagliptin and vildagliptin) rely on production of endogenous GLP-1 and act by reducing its turnover. The dipeptidyl peptidase-4 (DPP-4) inhibitors produce modest reductions in HbA1c (< 1%) compared with GLP-1 agonists and are generally weight-neutral. Neither GLP-1 agonists nor DPP-4 inhibitors cause hypoglycemia unless used with other agents known to increase risk. CONCLUSIONS: GLP-1 agonists and DPP-4 inhibitors provide a valuable new treatment option for patients with type 2 diabetes and may be associated with a wider range of therapeutic benefits than older drugs.|*PubMed[MESH]|Clinical Trials as Topic/*statistics & numerical data[MESH]|Diabetes Mellitus, Type 2/*drug therapy/*epidemiology[MESH]|Dipeptidyl-Peptidase IV Inhibitors/*administration & dosage[MESH]|Glucagon-Like Peptide 1/*analogs & derivatives/*therapeutic use[MESH]|Humans[MESH]|Treatment Outcome[MESH] |
