Incretins for blood sugar control and management
March 7 2017

The term "incretin" describes gut-stimulated hormones that communicate with the pancreas was proposed well before these hormones were ultimately isolated. These incretin hormones, known as glucose-dependent insulinotropic polypeptide (GIP) and GLP-1, are released with food intake and play an essential role in stimulating the pancreatic cell to provide insulin for glucose metabolism.2 So far, GLP-1 has proven to be a better target for drug development than GIP, primarily because GLP-1, unlike GIP, suppresses meal-stimulated elevations of glucagon, which has also been shown to improve appetite control. Within minutes of food reaching the gut, GLP-1 is secreted by L cells within the ileum and colon, rapidly signaling the beta cell. In addition to its role in stimulating insulin release, GLP-1 has been associated with regulating gastric emptying and promoting -cell proliferation and neogenesis.  Incretin therapies such as glucagon-like peptide 1 (GLP-1) agonists are commonly used for the treatment of type 2 diabetes mellitus.

In type 2 diabetes mellitus, two new classes of drugs have been developed that affect signaling between the gut and the pancreatic cell. One drug from each of these classes, dipeptidyl peptidase IV (DPP-IV) inhibitors and glucagon-like peptide-1 (GLP-1) mimetics, are now available for clinical use.

After hospitalization
Post hospital discharge management of diabetic patients is a challenge because of the availability of a wide variety of oral antidiabetes agents, including metformin, sulfonylureas, and thiazolidinediones, each with distinct therapeutic and adverse event profiles. Incretin-based therapies offer a potentially useful option for post-discharge therapy, and possibly for inpatient diabetes treatment. Incretins thus far appear to be well-tolerated; they are easier for patients to use compared with insulin injections (eg, continual glucose monitoring is not required); and they may provide long-term improvement of cardiovascular parameters and beta-cell function.

The incretin effect in diabetic control
DPP-IV inhibitors and GLP-1 mimetics act on a novel therapeutic target. Both affect the activity of incretin hormones, which communicate between the gut and the cell.

Alzheimers Dementia. 2014. The incretin hormones glucagonlike peptide 1 and glucose-dependent insulinotropic polypeptide are neuroprotective in mouse models of Alzheimer's disease.

Adverse reactions, negative effects
Incretin therapy may lead to abnormal pancreatic growth.

No association between an increased risk of acute pancreatitis and treatment with incretin therapy for type 2 diabetes was found in a large case control-study.