New RX for Type 2 DM

1
New RX for Type 2 DM

• Incretin related
• Gliptins (Sitagliptin, Vildagliptin)
• Synthetic exendin-4 (Exenatide)
• Glitazones
• Pioglitazone
• Rosiglitazone
• Glinides
• Repaglinide
• Netaglinide

2
Gliptins

• In response to a meal, glucagon-like peptide-1
  (GLP-1) and glucose-dependent insulinotropic
  peptide (GIP) are released (these hormones are
  termed incretin hormones)
• these incretin hormones stimulate insulin and
  suppress glucagon release (both in a
  glucose-dependent manner), delay gastric
  emptying, and increase satiety
• incretins are rapidly degraded by dipeptidyl
  peptidase-4 (DPP-4)

3
Gliptins

• DPP-4 inhibitors enhance meal-stimulated active
  GLP-1 and GIP levels by two- to threefold
• Once daily sitagliptin, BD vildagliptin
• Side effects GI/ nasopharyngeal/ WCC increase.
  Hypos rare
• Hba1c reduction greater with greater initial
  Hba1c (0.8 - 1.5)
• No study CVS end-points

4
Exenatide

• Incretin mimetic
• Twice Daily injection 5 or 10 mcg before a meal
  not closer than 6 hours apart. Not after a meal.
• Increase if needed after 1 month.
• Training
• GI side effects, headache. Hypos rare. Pan
• ? CVS end points

5
Exenatide

• exenatide therapy should be only continued if a
  beneficial metabolic response (at least 1.0
  percentage point HbA1c reduction in 6 months and
  a weight loss of at least 5 at 1 year) occurs
  and is maintained
• a body mass index over 35.0 kg/m2

6
Glinides

• Like a fast acting SU
• Less weight gain

7
Glitazone

• Not in cardiac failure
• No roziglitazone in IHD
• Neither if risk of osteoporosis