Role of Incretin Therapies in the Management of Type 2 Diabetes Mellitus: An Update

Introduction

Type 2 diabetes mellitus (T2DM) continues to burden the US health care system. Currently, 25.8 million people are believed to be inflicted with T2DM with 7 million of those being undiagnosed. Diabetes continues to be the leading cause of kidney failure, nontraumatic lower extremity amputations, and new cases of blindness. In addition, diabetes is a major contributor to heart disease and stroke. Direct medical costs associated with diabetes are approximately $116 billion with an additional $58 billion in indirect medical costs.1

Abstract

Despite the wide array of medications available for the treatment of type 2 diabetes mellitus, a significant number of patients remain uncontrolled. The traditional agents including metformin, sulfonylureas, and insulin have proven effective, however, adverse effects and precautions limit their use in certain patient populations. The incretin-based therapies, GLP-1 analogs and DPP-IV inhibitors, provide clinicians an additional tool in treating patients with type 2 diabetes. By replacing GLP-1 or inhibiting its breakdown, the beneficial effects of GLP-1 are able to persist. GLP-1 stimulates insulin secretion, slows gastric emptying, decreases glucagon, improves β-cell function, and reduces appetite. Several GLP-1 analogs and DPP-4 inhibitors have been approved by the FDA or are in various stages of development. Many of these agents have been previously reviewed by the authors, however, new data has become available. Although additional studies are necessary to determine the long-term safety and efficacy of these agents, these incretin-based therapies offer several advantages over existing therapy options.

Keywords

incretin, diabetes mellitus, DPP-IV inhibitors, GLP-1 analogs