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 ß 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 ß-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 ß 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 ß 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.