| Incretin-based therapies in the management of type 2 diabetes: rationale and reality in a managed care setting. | |
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MedLine Citation:
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PMID: 20809667 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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In addition to the hypoglycemia and weight gain associated with many treatments for type 2 diabetes, alpha-glucosidase inhibitors, thiazolidinediones, metformin, sulfonylureas, and the glinides do not address all of the multiple defects existing in the pathophysiology of the disease. Cumulatively, these oral agents address the influx of glucose from the gastrointestinal tract, impaired insulin activity, and acute beta-cell dysfunction in type 2 diabetes; however, until recently, there were no means to deal with the inappropriate hyperglucagonemia or chronic beta-cell-decline characteristic of the disease. The recently introduced incretin-based therapies serve to address some of the challenges associated with traditionally available oral antidiabetic agents. In addition to improving beta-cell function, stimulating insulin secretion, and inhibiting glucagon secretion, these agents reduce appetite, thereby stabilizing weight and/or promoting weight loss in patients with type 2 diabetes. Of the incretin-based therapies, both the dipeptidyl peptidase-4 (DPP-4) inhibitors and the glucagon-like peptide-1 (GLP-1) receptor agonists stimulate insulin secretion and inhibit glucagon secretion. The subsequent review outlines evidence from selected clinical trials of the currently available GLP-1 receptor agonists, exenatide and liraglutide, and DPP-4 inhibitors, sitagliptin and saxagliptin. Earlier and more frequent use of these incretin-based therapies is recommended in the treatment of type 2 diabetes, based on their overall safety and ability to achieve the glycosylated hemoglobin level goal. As such, both the American Diabetes Association and the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) treatment algorithms recommend the use of incretin-based therapy in both treatment-naive and previously treated patients. The AACE/ACE guidelines clearly state that these agents should not be limited to third- or fourth-line therapy. |
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Authors:
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Alan J Garber |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: The American journal of managed care Volume: 16 ISSN: 1936-2692 ISO Abbreviation: Am J Manag Care Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-09-02 Completed Date: 2011-01-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9613960 Medline TA: Am J Manag Care Country: United States |
Other Details:
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Languages: eng Pagination: S187-94 Citation Subset: H |
Affiliation:
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Division of Diabetes, Endocrinology, & Metabolism, Baylor College of Medicine, Ste 1000, Houston, TX 77030, USA. agarber@bcm.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adamantane
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analogs & derivatives,
economics,
therapeutic use Algorithms Diabetes Mellitus, Type 2 / drug therapy*, economics Dipeptides / economics, therapeutic use Dipeptidyl-Peptidase IV Inhibitors / economics, therapeutic use* Evidence-Based Medicine Glucagon / drug effects, secretion Glucagon-Like Peptide 1 / analogs & derivatives Hemoglobin A, Glycosylated Humans Hypoglycemic Agents / economics, therapeutic use* Incretins / economics, therapeutic use* Insulin / secretion Managed Care Programs / economics*, statistics & numerical data Peptides / economics, therapeutic use Pyrazines / therapeutic use Receptors, Glucagon / antagonists & inhibitors* Triazoles / therapeutic use Venoms / economics, therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Dipeptides; 0/Dipeptidyl-Peptidase IV Inhibitors; 0/Hemoglobin A, Glycosylated; 0/Hypoglycemic Agents; 0/Incretins; 0/Peptides; 0/Pyrazines; 0/Receptors, Glucagon; 0/Triazoles; 0/Venoms; 0/glucagon-like peptide receptor; 0/liraglutide; 0/saxagliptin; 0/sitagliptin; 11061-68-0/Insulin; 141732-76-5/exenatide; 281-23-2/Adamantane; 89750-14-1/Glucagon-Like Peptide 1; 9007-92-5/Glucagon |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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