DPP-4 inhibitors and GLP-1 analogues: for whom? Which place for incretins in the management of type 2 diabetic patients?

摘要: This review tries to delineate how insert the GLP-1 based agents, DPP4-inhibitors (sitagliptin and vildagliptin) analogues (exenatide liraglutide), in guidelines daily practice for management of type 2 diabetes (T2DM). Orally administered DPP-4 inhibitors reduce HbA(1c) by 0.5-1.1%, without hypoglycaemic events no weight gain. The subcutaneous injected show larger reductions 0.8-1.7% a loss (1.75-3.8 kg) with most gastrointestinal common adverse contributing significant treatment interruption. Regarding efficacy, cost safety these drugs they will challenge use metformin as initial therapy T2DM. In patients'not tolerating or older patients, seem be an excellent alternative monotherapy. Several studies argue favour combination promising second line treatment. offers advantages when compared others currently used, particularly if one considers more stringent higher risk patient receiving sulfonylureas mild hyperglycaemia gain thiazolidinedione (TZD). Oral triple therapy, + TZD incretin-based drug, has several theoretical but is not supported any published trial. Finally, obtaining acceptance injections once twice vs. oral administration OADs probably remain difficult during first years many patients. Nevertheless long-acting release exenatide formulation (i.e. weekly), injection patients under development shows preliminary results. If confirmed, this new class should largely developed from monotherapy combinations (bitherapy tritherapy), even instead insulin association insulin. long-term effect agents on glycaemic control yet been established, their potential impact beta-cell function humans remains area active investigation. So, further are required allow progressively determining T2DM strategy. Their strategies, really evaluated physicians real large long term systematic surveys, recently shown other therapeutic fields.