GLP-1 based therapies represent a significant advancement in the treatment of T2DM due to their ability to target multiple pathophysiologies of the disease. Although the first GLP-1 receptor agonist (exenatide BID) was approved by the FDA in 2005 and the first DDP-4 inhibitor, sitagliptin, was approved the following year, the differences in pharmacokinetics and magnitude of effects between these two classes of incretin-based therapies are not completely understood by clinicians. In addition, a lack of consensus in the existing guidelines regarding the preferred choice of these agents in the treatment algorithm further complicate physicians’ therapeutic decisions (Fineman 2012). Short-acting GLP-1 receptor agonists should be considered early in the disease and as part of combination therapy for patients close to glycemic goals when post-prandial glucose control is more important. Long-acting GLP-1 receptor agonists should be considered when fasting glucose elevations are the main problem, and when weight loss would be beneficial. DPP-4 inhibitors could be used in patients with mild to moderate fasting hyperglycemia, need to maintain bodyweight, or when subcutaneous injections or gastrointestinal side effects limit the use of GLP-1 receptor agonists.
Understanding the physiology of incretins; the pharmacokinetics differences between incretin-based therapies; their effects on FPG, PPG and bodyweight; and the efficacy and safety profile of these agents are all of fundamental importance to target glycemic disturbances. By targeting these specific areas, we can offer more individualized therapy for T2DM patients in order to improve glycemic control and delay disease progression.
Fineman MS, Cirincione BB, Maggs D, Diamant M. GLP-1 based therapies: differential effects on fasting and postprandial glucose. Diabetes Obes Metab. 2012 Aug;14(8):675-88.
This activity is designed to meet the educational needs of endocrinologists, primary care physicians, nurses, pharmacists, and other healthcare practitioners caring for diabetes patients.
After completion of this activity, participants will be able to:
- Describe the physiologic effects of incretin hormones on beta-cell dysfunction, glucose regulation and multi-organ systems
- Explain the different mechanisms of action of GLP-1 receptor agonists and DPP-4 inhibitors and their capacity for controlling postprandial glucose and fasting plasma glucose
- Contrast and compare the efficacy and safety of GLP-1 agonists and DPP-4 inhibitors in clinical trials
Jack L. Leahy, MD
Professor of Medicine
Chief, Division of Endocrinology, Diabetes, and Metabolism
University of Vermont College of Medicine
CME Advisory Committee
Course Director/Course Reviewer
M. Susan Burke, MD, FACP
Clinical Assistant Professor, Internal Medicine
Thomas Jefferson University Medical School
Senior Advisor, Internal Medicine Clinical Care Center
Director of CME/CE
Med Learning Group
The Quill Consulting
Margaret Governo, EdD, APRN BC
CCM Lead Nurse Planner
Ultimate Medical Academy
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Disclosure of Conflicts of Interest
Jack L. Leahy, MD
Disclosure: Dr. Leahy receives a Research Grant from Takeda Pharmaceuticals. Dr. Leahy also receives Consulting Fees from Janssen, Merck & Co., Inc., Novo Nordisk, Sanofi, and Valeritas.
M. Susan Burke, MD
Disclosure: Dr. Burke receives Consulting Fees from Iroko and Merck & Co., Inc.
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Christopher Drury, of The Quill Consulting has no relevant financial relationships to disclose.
Margaret Governo, EdD, APRN BC has no relevant financial relationships to disclose.
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Release Date: October 31, 2013
Expiration Date: October 30, 2014
Estimated Time to Complete This Educational Activity: 60 minutes
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