The Journal of Clinical Endocrinology & Metabolism Vol. 92, No. 4 0
Copyright © 2007 by The Endocrine Society
Patient Information Page from The Hormone Foundation |
Diabetes and Incretin-based Therapy
Mark E. Molitch, MD and
Guillermo Umpierrez, MD
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What is diabetes and what are the risks?
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Diabetes is a disease characterized by levels of glucose (sugar) in the bloodstream that are higher than normal. Glucose is produced by the body from the foods that you eat. Insulin, which is produced by the pancreas (an organ located in your abdomen), takes the glucose from the bloodstream and carries it into your cells where it is used for energy.
Diabetes occurs when the pancreas does not produce insulin (called type 1, or insulin-dependent, diabetes) or when the body becomes resistant to the effects of insulin (called type 2, or non-insulin-dependent, diabetes). In either case, the result is that glucose does not enter the cells and builds up in the bloodstream.
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How is diabetes treated?
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Keeping blood sugar levels as close to normal is key to the prevention of a number of serious complications from diabetes including heart disease, stroke, kidney disease, blindness, and nerve damage.
Treatment for diabetes depends on the type of diabetes you have and how well you respond to treatments. To keep blood glucose levels as close to normal the most common treatment options are:
- Lifestyle changes (diet and exercise)
- Oral (by mouth) medications
- Insulin therapy
Recently, attention has turned to a new line of therapy using substances called incretins for patients with type 2 diabetes. GLP-1 is an important incretin hormone that helps normalize blood sugar levels.
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How do incretins affect blood sugar levels?
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After you eat, your intestines release incretins such as GLP-1 into the bloodstream. GLP-1 affects blood sugar by: - Increasing insulin produced by your pancreas
- Decreasing glucagon release (Glucagon is a hormone that controls the release of glucose, or sugar, from the liver after meals.)
- Promoting a feeling of fullness after a meal, which means that you eat less
- Slowing the emptying of the stomach’s contents into the intestines, which lowers blood sugar levels after a meal
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What is incretin-based therapy?
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There are two types of incretin-based drugs that improve the effects of GLP-1 in controlling blood sugar—Incretin mimetics and DPP-IV inhibitors.
Incretin mimetics:
An incretin mimetic, such as exenatide, copies (or mimics) the action of GLP-1 that is produced by your body. The difference between the two is that exenatide last about 10 hours, whereas GLP-1 only lasts about 2 minutes. Exenatide has been shown to improve diabetes control and to produce weight loss in most patients (average of 6-10 pounds).
Exenatide is used alone or in combination with other antidiabetic drugs, such metformin and sulfonylureas. It may also be used with insulin. Exenatide is given by injection twice a day, usually before breakfast and dinner. The main side effect is nausea. There’s also a possible risk of low blood sugar, especially when exenatide is used in combination with a sulfonylurea or insulin.
DPP-IV inhibitors:
GLP-1 is rapidly inactivated in the blood by an enzyme called DPP-IV. DPP-IV inhibitors work by stopping the breakdown of GLP-1. This makes GLP-1 last longer and, in turn, increases the levels of GLP-1 in your blood. DPP-IV inhibitors (for example, sitagliptin and vildagliptin) may be used alone or in combination with other antidiabetic drugs. These drugs are fairly well tolerated by most patients, have minimal side effects and are usually not associated with weight changes during therapy.
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When is incretin-based therapy used?
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Both exenatide and DPP-IV inhibitors may be used in people with poorly controlled diabetes. They are used alone or in combination with other antidiabetic medications. Both lower blood sugar levels; in addition, exenatide may be associated with some weight loss.
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What should you do with this information?
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If you have type 2 diabetes and want to know if incretin-based therapy might benefit you, talk with your doctor. An endocrinologist, an expert in hormones, can help diagnose, treat, and manage your diabetes.
No matter what the treatment plan, managing your diabetes requires that you maintain a healthy lifestyle that includes a balanced meal plan and regular exercise. Follow your doctor’s recommendations for treatment and regularly monitor your blood sugar to avoid high or low blood sugar.
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Resources:
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- Find-an-Endocrinologist: www.hormone.org or call 1-800-HORMONE (1-800-467-6663)
- Diabetes Information: www.hormone.org
- American Diabetes Association: www.diabetes.org
- National Diabetes Education Program (NIH): http://ndep.nih.gov
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Footnotes
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For more information on how to find an endocrinologist, download free publications, translate this fact sheet into other languages, or make a contribution to The Hormone Foundation, visit www.hormone.org or call 1-800-HORMONE (1-800-467-6663). The Hormone Foundation, the public education affiliate of The Endocrine Society (www.endo-society.org), serves as a resource for the public by promoting the prevention, treatment, and cure of hormone-related conditions. This page may be reproduced non-commercially by health care professionals and health educators to share with patients and students.
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What is diabetes and...
How is diabetes treated?
