"Newer" Non-Insulin Analogues Flashcards
List the 3 “newer” options of non-insulin analogues.
- GLP-1 agonist
- DPP-IV inhibitor
- SGLT2 inhibitor
What are incretins?
Gut peptides that modulate insulin secretions in response to nutrients in the bowel
GLP-1 Agonist MOA
- Stimulate GLP-1 receptor in incretin system
- **Stimulates insulin secretion, inhibition of glucagon secretion, hepatic glucose production, gastric emptying, and appetite
DPP-IV MOA
-Prevent peptide inactivation by DPP-IV –> inc active levels of incretin hormones
What are the GLP-1 Agonists? Which is the only PO option?
- Exenatide
- Semaglutide (PO or SC)
- Liraglutide
- Lixisenatide
- Dulaglutide
GLP-1 Agonist Indications
- Mono/combo therapy
- Weight loss aid (higher dose liraglutide) w/ diet and exercise
- 10# weight loss at 1 yr
- Approved for pts with or without DM and BMI 30 or higher or 27 or higher and weight-related condition
GLP-1 Agonist Pearls
- **Dec A1c 1-1.5%, weight loss/appetite suppression (sema, lira dula, ER exenatide > others)
- Rare hypoglycemia
- **Store in fridge
- Antibodies may develop
GLP-1 Agonist Precautions/CI
- CKD
- **Slows gastric emptying–> CI in mod-severe gastroparesis!
- Thyroid issue–> refer to JB
GLP-1 Agonist ADRs
- GI intolerance (nausea) IR >ER
- BBW thyroid cancer
- **Acute pancreatitis/pancreatic CA–> monitor high risk pts
- Biliary/GB dz?
What are the DPP-IV Inhibitors?
- Sitagliptin*
- Saxagliptin
- Linagliptin*
- Alogliptin
DPP-IV Inhibitors Indications
-Mono/combo therapy
DPP-IV Inhibitor Pearls
- Dec A1c 0.5-1.0%
- **More effective at reducing postprandial BG than fasting BG
- Weight neutral
DPP-IV ADRs
- Caution w CKD
- Hypersensitivity rxn (urticaria)
- **Acute pancreatitis/cancer
- Severe joint pain (rare)
You want to put your DMII patient on an SGLT2 inhibitor. Which one will you choose?
Empagliflozin
SGLT2 Inhibitor MOA
- SGLT2 is transmembrane protein in kidney
- SGLT2 inhibition dec glucose/Na reabsorption, inc urinary glucose/Na, and dec [BG]/BP