Maximizing the
Role of GLP-1 Agonists in Our Patients with Type 2 Diabetes
Physiology
Consumption of food leads to a rise in a glucose levels.
This rise in glucose leads to release of incretins from the intestines,
specifically the duodenum to stimulate a decrease in blood glucose levels. The two types of incretin are glucagon-like
peptide (GLP) and glucose dependent insulinotropic polypeptide or gastric
inhibitor polypeptide (GIP). GLP1 acts
on the brain to promote satiety and reduce appetite, acts on the pancreas alpha
cells to decrease postprandial glucagon secretion, acts on the pancreas beta
cells to increase glucose dependent insulin secretion, acts on the liver to
decrease glycogenolycis (due to decrease glucagon secretion), acts on the gastro
intestinal tract to slow gastric emptying.
GLP1 agonists drugs
·
Short
acting à lower postprandial glucose
Exenatide short acting BID
·
Long
acting à lower postprandial glucose and fasting
Exentaide long acting weekly
Liraglutide
Albiglutide
Dulaglutide
Side effects of
GLP1 agonists
Weight loss
Stomach upset – patients should eat smaller/frequents
meals
Caution with pancreatitis
Storage of GLP1
pens
Refrigerate unopened pens
Room temperate pens sting less
GLP1 pens vs
insulin pens
GLP1 pens should be primed initially
Insulin pens should be primed each time
GLP1 agonists vs
DPP4 inhibitors
DPP4 inhibitors raise GLP1 to endogenous levels
GLP1 agonists raise GLP1 much higher
Pharmacotherapy
options for diabetes treatment
·
Bolus
insulin
Lispro (Humalog)
Aspart (Novolog)
Glulisine (Apidra)
Inhaled (Afrezza)
Regular (Humulin R, Novolin R)
·
Basal
insulin
NPH (Humulin N, Novolin N)
Detemir (Levemir)
Glargine U100;U300 (Lantus,
Toujeo)
·
Non-insulin
injectables
Glucagon like peptide 1 agonists
– exenatide, liraglutide, albaglutide, dulaglutide
Amylinomimetic – pramlintide
·
Oral
Alpha glucosidase inhibitors –
acarbose, miglitol
Biguanides – metformin
Bile acid sequestrants –
cholestyramine, colestipol, colesevelam
Dipeptidyl peptidase 4
inhibitors – sitagliptin, saxagliptin
Dopamine agonists –
bromocriptine
Glinides – nateglinide,
repaglinide
Sulfonylureas – glipizide,
glimepiride
Sodium glucose co-transporter 2
inhibitors – canagliflozin, dapagliflozin
Thiazolidinediones –
rosiglitazone, pioglitazone
Weight changes
with antihyperglycemic agents added to metformin
Drugs causing
weight gain
Insulin* (most gain)
Thiazolidinediones*
Sulfonylureas*
Glinides*
Dipeptidyl peptidase 4 inhibitors (least gain)
|
Drugs causing
weight loss
Alpha glucosidase inhibitor (least loss)
Glucagon like peptide 1 agonists
Sodium glucose co-transporter 2 inhibitors (most loss)
|
