 GLP
-1 (gut hormone) + GIP = incretin effect
=Augmentation of insulin after oral glucose
 Type


2 diabetics little incretin effect
Reduced GLP-1 secretion
GIP lost insulinotropic property
 GLP-1
 Only
broken down by DPP-4
for type 2 diabetes
 Inhibits
incretin breakdown
 Indirectly
increase own insulin secretion
 Moderate
HBA1c reduction (~1%)
 Which
one to choose?
 Start
– 2nd
line: Metformin or Sulphonylurea +
HBA1c ≥ 6.5% + not suitable for other one
– 3rd line: Metformin + Sulphonylurea +
HBA1c ≥ 7.5%
– Thiazolidinedione
is an alternative in 2nd
line case but not 3rd
•
Continue
– HBA1c
reduces by ≥ 0.5% in 6 months
 DPP-4
Inhibitor if:
 Weight gain would cause significant
problem
 Thiazolidinedione contraindicated

eg heart failure
 Previous
intolerance or poor response
to Thiazolidinedione
 GLP
-1 (gut hormone) + GIP = incretin effect
=Augmentation of insulin after oral glucose
 Type


2 diabetics little incretin effect
Reduced GLP-1 secretion
GIP lost insulinotropic property
 GLP-1
 Only
broken down by DPP-4
for type 2 diabetes
Effects:
 Stimulates post-prandial insulin
secretion
 Slows gastric emptying
 Reduces appetite
Administered:
 Subcutaneous injection
 Twice daily
Less
hypos compared to insulin
BIG benefit of weight loss
Only licensed to lower blood sugars,
not as weight loss agent
Nausea and vomiting
 £830
per person per year
 Start:
 BMI
≥ 35 (+ probs assoc. with high wt)
 BMI < 35 + insulin unacceptable or weight
loss beneficial to co-morbidities
 Continue Metformin and Sulphonylurea
 Combination with insulin
 Continue:
 HbA1c
reduction ≥ 1.0% AND
 Initial body weight reduction ≥ 3%
 Metformin
still first line
 DPP-4
Inhibitors alternative where
Thiazolidinediones were previously
only other oral option
 Exenatide
- good for weight loss but
?help in sugar control
 Further
new drugs on their way