Incretin-related therapies in type 2 diabetes: A practical overview

Abstract

Progressive deterioration of the incretin system has been shown to be a key component of the pathophysiology of type 2 diabetes. Improved understanding of the physiology underlying incretins has led to the development of new therapies that act through modulation of the incretin system. These agents offer some potential advantages over previous antidiabetes drugs and have been approved for use in type 2 diabetes. There are two broad classes of incretin-related therapies: dipeptidyl peptidase-4 inhibitors (sitagliptin and saxagliptin) and glucagon-like peptide-1 receptor agonists (exenatide and liraglutide). Although the two classes have some benefits in common - notably a low risk of hypoglycemia - they can be differentiated in terms of their pharmacology, efficacy and safety profiles, and clinical considerations. Introducing new therapies into everyday clinical use requires careful consideration of the practical implications of their use and how they fit in with current treatment regimens. With regard to incretin-related therapies, some patients with type 2 diabetes may benefit more from their use than others, whereas their use in a small subset of patients with type 2 diabetes should be avoided. With appropriate provider and patient education about the potential benefits and practicalities of incretin-related therapies, these agents should prove to be a valuable resource in type 2 diabetes management.