Pro and Contra of Incretin therapy in Type 2 diabetes
Incretins are group of gastroinestinal hormones involved in glucoregulation . Two main hormones involved in glucoregulation are glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide or glucose-dependent insulinotropic polypeptide (GIP) . Both are rapidly inactivated by the enzime dipeptidyl peptidase-4 (DPP-4) . Incretin based therapies include GLP-1 receptor agonists and DPP-4 inhibitors . Their main mechanisms of actions are to increase insulin and inhibit glucagon secretion, reduce gastric emptying and reduce food intake . Positive effects on glycemia without hypoglycemia and weight gain are their main advantages . Direct cardiovascular effects of GLP-1 receptor agonists are also documented . Concerns have been raised that incretin based therapies were associated with an increased risk of pancreatitis and pancreatic cancer . Recent trials do not support the hypothesis . Preclinical studies in animals have suggested that incretin based therapies could be associated with thyroid C-cell cancer . However, it was not found in humans . Recent trial of one DPP-4 inhibitor suggested increased risk for hospitalization due to heart failure . Further studies are required . Several large clinical trials are in progress . In presentation pro et contra of incretin based therapies will be presented . The practical issues in Type 2 diabetes management pharmacogenomic consideration