Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-25

Table 2. Differentiating the effects of incretin mimetics (24,48,49,51) Effectiveness GLP-1 Analogues

DPP-IV Inhibitors

Five-fold

Two-fold

Increase in levels of GLP-1 following administration

Pancreatic: Increase beta cell mass

Moderate

Small

Moderate

Small

Beta cells: Stimulate glucose dependent insulin secretion Alpha cells: Decrease postprandial glucagon secretion Hepatic: Suppress postprandial glucagon production

Moderate

Small

Moderate

Small

GI: Delayed gastric emptying

Moderate

Negligible

Moderate

Negligible

CNS: Increase satiety signaling and reduces appetite

Weight loss

Moderate

Negligible

A1C lowering

↓ 1.0-1.5%

↓ 0.5–0.7%

CV benefit / safety

CV safety: lixisentide CV safety and benefit: Dulglutide, liraglutide, s.c. semaglutide

No DPP-4i has shown inferiority or superiority compared to placebo for the risk of major CV events. (Note: Saxagliptin was associated with an increased incidence of hospitalization for heart failure.)

Administration

Subcutaneous injection / Oral Tablet

Oral Tablet

A1C = glycated hemoglobin; CNS = central nervous system; GI= gastrointestinal