J Korean Med Assoc.  2009 Oct;52(10):1030-1036. 10.5124/jkma.2009.52.10.1030.

Incretin-based Combination Therapy in Type 2 Diabetes Mellitus

• Kim JH
• Lee MS

• KMID: 2188084
• DOI: http://doi.org/10.5124/jkma.2009.52.10.1030

Abstract

While there are many therapies for type 2 diabetes are available including insulin secretagogues, insulin sensitizers and exogenous insulin, many patients are unable to reach recommended therapeutic targets. Incretin-based therapies have recently been introduced into clinical practice, and these novel therapies may make it possible to achieve improved glycemic control either with no weight gain (dipeptidyl peptidase-4 [DPP-4] inhibitors sitagliptin and vildagliptin, or with weight loss (glucagon-like peptide-1 [GLP-1] mimetics exenatide and liraglutide). This article aims to provide an overview of efficacy and safety data regarding incretinbased clinical trials in type 2 diabetic patients, and propose a systematic approach to treatment including patient selection and optimal treatment combination. In addition, preclinical data suggest that incretin-based therapies may also preserve-cell function. Therefore, these agents hold out promise of a truly disease-modifying therapy that would target the progressive nature of type 2 diabetes. Additional clinical trials will be required to test such hypothesis.

Keyword

DPP-4 inhibitors; GLP-1 mimetics; Incretin; Type 2 diabetes

MeSH Terms

Adamantane
Diabetes Mellitus, Type 2
Humans
Incretins
Insulin
Nitriles
Patient Selection
Peptides
Pyrazines
Pyrrolidines
Sitagliptin Phosphate
Triazoles
Venoms
Weight Gain
Weight Loss
Adamantane
Incretins
Insulin
Nitriles
Peptides
Pyrazines
Pyrrolidines
Triazoles
Venoms

Figure

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  Figure 1 Redefining of pathophysiology of type 2 diabetes. Insulin resistance, β-cell dysfunction, and impaired incretin effects play a significant role in the development and progression of hyperglycemia in type 2 diabetes.

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