Efficacy and safety of incretin based therapies: clinical trial data.

Abstract

OBJECTIVE:

Provide a comprehensive overview of efficacy and safety data on incretin-based agents in the treatment of type 2 diabetes.

DATA SOURCES:

A PubMed search was conducted for the years 2000-2009, using as keywords the names of glucagon-like peptide-1 (GLP-1) receptor agonists (exenatide and liraglutide) and dipeptidyl peptidase-4 (DPP-4) inhibitors (sitagliptin, alogliptin, and saxagliptin). World Diabetes Congress abstracts from 2008 to 2009 were also searched for clinical studies of these agents.

STUDY SELECTION:

The author included randomized controlled trials of incretin therapies that were published in English and enrolled > or =100 participants.

DATA EXTRACTION:

Data on the effects of incretins on glycemic control, weight, beta-cell function, blood pressure, lipid levels, safety, and tolerability were extracted and summarized.

DATA SYNTHESIS:

A total of 27 randomized controlled studies of incretin therapy were identified and included in the review. GLP-1 receptor agonists and DPP-4 inhibitors were evaluated at different points in the diabetes treatment spectrum, i.e., added to diet and exercise alone (monotherapy) or added to oral antihyperglycemic regimens (combination therapy).

CONCLUSION:

In addition to decreasing glycemia in type 2 diabetes, incretin therapies may improve other important parameters, including beta-cell function, blood pressure, and lipid levels, with a low risk for hypoglycemia. A comparison of the study data differentiates the clinical profiles of the GLP-1 receptor agonists, which are associated with weight loss, and DPP-4 inhibitors, which are weight neutral, as well as the individual agents within each class.

• Authors: John White
• Journal: Journal of the American Pharmacists Association : JAPhA (J Am Pharm Assoc (2003)) 2009 Sep-Oct Vol. 49 Suppl 1 Pg. S30-40 ISSN: 1544-3450 [Electronic] United States
• PMID: 19801363 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Blood Glucose
• Dipeptidyl-Peptidase IV Inhibitors
• GLP1R protein, human
• Glucagon-Like Peptide-1 Receptor
• Glycated Hemoglobin A
• Hypoglycemic Agents
• Incretins
• Insulin
• Lipids
• Receptors, Glucagon
• hemoglobin A1c protein, human
• DPP4 protein, human
• Dipeptidyl Peptidase 4

Topics

• Blood Glucose (drug effects)
• Blood Pressure (drug effects)
• Diabetes Mellitus, Type 2 (drug therapy, metabolism)
• Dipeptidyl Peptidase 4 (metabolism)
• Dipeptidyl-Peptidase IV Inhibitors (administration & dosage, adverse effects, therapeutic use)
• Drug Administration Schedule
• Evidence-Based Medicine
• Glucagon-Like Peptide-1 Receptor
• Glycated Hemoglobin (metabolism)
• Humans
• Hypoglycemic Agents (administration & dosage, adverse effects, therapeutic use)
• Incretins (metabolism)
• Insulin (metabolism)
• Insulin-Secreting Cells (drug effects, metabolism)
• Lipids (blood)
• Randomized Controlled Trials as Topic
• Receptors, Glucagon (agonists, metabolism)
• Treatment Outcome
• Weight Loss (drug effects)