New Diabetes Drugs DPP-4 Inhibitors Exenatide

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New Diabetes DrugsDPP-4
InhibitorsExenatide

• Katy Daniels

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Incretin effect

• GLP -1 (gut hormone) GIP incretin effect
• Augmentation of insulin after oral glucose
• Type 2 diabetics little incretin effect
• Reduced GLP-1 secretion
• GIP lost insulinotropic property
• GLP-1 broken down by DPP-4
• Only for type 2 diabetes

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DPP-4 Inhibitors Sitagliptin,
Vildagliptin

• Inhibits incretin breakdown
• Indirectly increase own insulin secretion
• Moderate HBA1c reduction (1)
• Which one to choose?

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DPP-4 Inhibitors Sitagliptin, Vildagliptin

• Start
• 2nd line Metformin or Sulphonylurea HBA1c
  6.5 not suitable for other one
• 3rd line Metformin Sulphonylurea HBA1c
  7.5
• Thiazolidinedione is an alternative in 2nd line
  case but not 3rd
• Continue
• HBA1c reduces by 0.5 in 6 months

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DPP-4 Inhibitor vs Thiazolidinedione

• DPP-4 Inhibitor if
• Weight gain would cause significant problem
• Thiazolidinedione contraindicated
• eg heart failure
• Previous intolerance or poor response to
  Thiazolidinedione

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Incretin effect

• GLP -1 (gut hormone) GIP incretin effect
• Augmentation of insulin after oral glucose
• Type 2 diabetics little incretin effect
• Reduced GLP-1 secretion
• GIP lost insulinotropic property
• GLP-1 broken down by DPP-4
• Only for type 2 diabetes

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GLP 1 Mimetic - Exenatide

• Effects
• Stimulates post-prandial insulin secretion
• Slows gastric emptying
• Reduces appetite
• Administered
• Subcutaneous injection
• Twice daily

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Exenatide

• Less hypos compared to insulin
• BIG benefit of weight loss
• Only licensed to lower blood sugars, not as
  weight loss agent
• Nausea and vomiting
• 830 per person per year

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Exenatide

• Start
• BMI 35 ( probs assoc. with high wt)
• BMI lt 35 insulin unacceptable or weight loss
  beneficial to co-morbidities
• Continue Metformin and Sulphonylurea
• Combination with insulin
• Continue
• HbA1c reduction 1.0 AND
• Initial body weight reduction 3

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Conclusion

• Metformin still first line
• DPP-4 Inhibitors alternative where
  Thiazolidinediones were previously only other
  oral option
• Exenatide - good for weight loss but ?help in
  sugar control
• Further new drugs on their way