Pharmacological treatment of
type 2 diabetes has been enriched during recent years, with the launch of
incretin therapies targeting
glucagon-like peptide-1 (GLP-1). Such medications comprise either
GLP-1 receptor agonists, with short (one or two daily
injections:
exenatide,
liraglutide,
lixisenatide) or long duration (one injection once weekly: extended-released
exenatide,
albiglutide,
dulaglutide,
taspoglutide); or oral compounds inhibiting dipeptidyl peptidase-4 (DPP-4), the
enzyme that inactives
GLP-1, also called
gliptins (
sitagliptin,
vildagliptin,
saxagliptin,
linagliptin,
alogliptin). Although both pharmacological approaches target
GLP-1, important differences exist concerning the mode of administration (
subcutaneous injection versus oral ingestion), the efficacy (better with
GLP-1 agonists), the effects on
body weight and systolic blood pressure (diminution with agonists versus neutrality with
gliptins), the tolerance profile (
nausea and possibly
vomiting with agonists) and the cost (higher with
GLP-1 receptor agonists). Both agents may exert favourable cardiovascular effects.
Gliptins may represent a valuable alternative to a sulfonylurea or a glitazone after failure of monotherapy with
metformin while
GLP-1 receptor agonists may be considered as a good alternative to
insulin (especially in obese patients) after failure of a dual oral
therapy. However, this scheme is probably too restrictive and modalities of using
incretins are numerous, in almost all stages of
type 2 diabetes. Physicians may guide the pharmacological choice based on clinical characteristics, therapeutic goals and patient's preference.