Abstract
Antidiabetic agents based on the incretin system change paradigms of type 2 diabetes therapy. The incretins - incretin mimetics (GLP-1 agonists) and dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors) - affect glucose homeostasis by increasing insulin secretion in a glucose-dependent way.
However, they also correct other metabolic abnormalities in type 2 diabetes and positively affect microvascular as well macrovascular complications - the cardiovascular risk. Moreover, incretins promise to meet optimal glycemic control in these patients.
The author describes in more detail the biological mechanism of action of incretins and steps taken in using GLP-1 agonists in the treatment of 2 type diabetes mellitus. Exenatide was the first to be introduced in the treatment of type 2 diabetes mellitus. followed by liraglutide - an analogue of human GLP-1, later exenatide LAR and other analogues in an attempt to prolong the action and future prospects of therapeutic trends.
Gliptiny are drugs based on inhibition of enzymatic activity of DPP-4. The first was the DPP-4 inhibitor sitagliptin, with which the users in the Czech Republic have the largest clinical experience.
Moreover, vildagliptin and saxagliptin are also available. Fixed combinations of gliptins with metformin are advantageous, namely Janumet and Eucreas.
The incidence of adverse effects is low, and intolerance of these drugs is not a serious problem. Possible more serious side effects are discussed, currently subject to study.
However, no causal link between incretins and a higher risk of malignancy and/or additional more serious complications has been shown to date. In the future, incretins will probably necessitate changes in type 2 diabetes treatment algorithm, because they prevent the progressive loss of B-cell function.
Incretin therapy offers an option of simultaneous therapeutic intervention, and they have a positive protective effect, as regards any development of diabetic, particularly cardiovascular complications.