glp -1 (gut hormone) + gip = incretin effect =augmentation of insulin after oral glucose type 2...
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GLP -1 (gut hormone) + GIP = incretin effect
=Augmentation of insulin after oral glucose
Type 2 diabetics little incretin effect Reduced GLP-1 secretion GIP lost insulinotropic property
GLP-1 broken down by DPP-4
Only for type 2 diabetes
Inhibits incretin breakdown
Indirectly increase own insulin secretion
Moderate HBA1c reduction (~1%)
Which one to choose?
Start– 2nd line: Metformin or Sulphonylurea +
HBA1c ≥ 6.5% + not suitable for other one
– 3rd line: Metformin + Sulphonylurea + HBA1c ≥ 7.5%
– Thiazolidinedione is an alternative in 2nd line case but not 3rd
• Continue–HBA1c reduces by ≥ 0.5% in 6 months
DPP-4 Inhibitor if:Weight gain would cause significant problem
Thiazolidinedione contraindicated eg heart failure
Previous intolerance or poor response to Thiazolidinedione
GLP -1 (gut hormone) + GIP = incretin effect
=Augmentation of insulin after oral glucose
Type 2 diabetics little incretin effect Reduced GLP-1 secretion GIP lost insulinotropic property
GLP-1 broken down by DPP-4
Only for type 2 diabetes
Effects: Stimulates post-prandial insulin
secretion Slows gastric emptying Reduces appetite
Administered: Subcutaneous injection Twice daily
Less hypos compared to insulin BIG benefit of weight loss Only licensed to lower blood
sugars, not as weight loss agent Nausea and vomiting
£830 per person per year
Start:BMI ≥ 35 (+ probs assoc. with high wt)BMI < 35 + insulin unacceptable or weight loss beneficial to co-morbidities
Continue Metformin and SulphonylureaCombination with insulin
Continue:HbA1c reduction ≥ 1.0% AND Initial body weight reduction ≥ 3%