Diabetes Mellitus: GLP-1 & The New Drugs Flashcards
How does GLP-1 (Incretin) works in normal physiology?
In T2DM patients, what has happened to their Incretin (GLP-1)?
They don’t produce as much and thus lose regulation over their sugar & insulin levels.
Describe 2 new drugs that affect Incretin (GLP-1).
- GLP-1 mimetics - GLP-1 is produced by an oral carbohydrate bolus. It increase the levels of GLP-1 in the body and thus the body is able to better regulate insulin and sugar. (e.g. Exenatide)
- DPP-4 Inhibitors - GLP-1 does not last for long because it is broken down by DPP-4 enzyme. These DPP-4 inhibitors stop the degradation of GLP-1. (e.g. Gliptins)
What is one of the major advantages of GLP-1 mimetics (Exenatide) over other treatments?
It typically results in weight loss whilst medciations like insulin, sulfonylureas(e.g. gliclazide) and thiazolidinediones (e.g. glitazones) can result in weight gain.
How must exenatide be given?
It must be given by subcutaneous injection within 60 minutes before the morning and evening meals and should not be given after meals.
Exenatide is the name of one GLP-1 mimetic. What is a name for another?
Liraglutide
What is an advantage of liraglutide over exenatide?
It only needs to be given once daily whilst exenatide is given twice daily.
When does NICE suggest that we add exenatide to metformin and a sulfonylurea?
- BMI >= 35 kg/m2 in people of European descent and there are problems associated with high weight
- BMI < 35 kg/m2 and insulin is unacceptable because of occupational implications or weight loss would benefit other comorbidities.
In order to justify the use of GLP-1 mimetics, what does NICE expect to see after 6 months of use?
A 1% reduction in HbA1C and a 3% weight loss.
What are the main side effects of exanetide?
- N&V (main one)
- Severe Pancreatitis
How are DPP-4 inhibitors taken?
Orally
Do DPP-4 inhibitors cause weight gain/
No
Name some DPP-4 inhibitors.
Vildagliptin
Sitagliptin
Do DPP-4 (Vidagliptin, sitagliptin) inhibitors cause hypoglycaemia?
No
What are NICE’s guidelines regarding DPP-4 inhibitors?
- Continue DPP-4 inhibitor only if there is a reduction of > 0.5 percentage points in HBA1c in 6 months
- NICE suggest that a DPP-4 inhibitor might be preferable to a thiazolidinedione if:
- Further weight gain would cause significant problems
- A thiazolidinedione is contraindicated
- The person has had a poor response to a thiazolidinedione