Safety and benefit of incretin-based therapies in patients with type 2 diabetes: learnings and reflections
Abstract
Over the past two decades, the treatment landscape for type 2 diabetes (T2DM) has witnessed a remarkable increase in the number of drug classes available for the management of hyperglycemia; in addition to the traditional medications, several newer agents have found their place in the multi-targeted approach to controlling this global health challenge, even bringing diabetes to remission. Among novel antidiabetic agents are the incretin-based therapies (IBTs), working on the gastrointestinal-hepatopancreatic-brain axis through the modulation of gut-derived hormones that play a vital role in maintaining euglycemia and regulating appetite.
Two major classes of IBTs are at hand to accomplish this goal; the glucagon-like peptide-1 receptor agonists (GLP-1RA) largely mimic the actions of GLP-1 and can best be viewed as supplementary therapies. On the other hand, the dipeptidyl peptidase-4 inhibitors (DPP-4i) serve to prolong the half-life of native GLP-1 and enhance its inherent favorable actions; thus, their action is dependent on the presence of an intrinsic reserve of gut-derived hormones.