• Sten Madsbad, Thure Krarup, Carolyn F Deacon, and Jens J Holst.
• Department of Endocrinology, Hvidovre University Hospital, Hvidovre and University of Copenhagen, Copenhagen N, Denmark. sten.madsbad@hva.regionh.dk
• Curr Opin Clin Nutr Metab Care. 2008 Jul 1; 11 (4): 491-9.

Purpose Of ReviewTo discuss the virtues and shortcomings of the glucagon-like peptide-1 receptor agonists and the dipeptidyl peptidase-4 inhibitors in the treatment of type 2 diabetes.Recent FindingsThe injectable glucagon-like peptide-1 receptor agonists exenatide significantly improves glycaemic control, with average reductions in haemoglobin A1c of about 1.0%, fasting plasma glucose of about 1.4 mmol/l, and causes a weight loss of approximately 2-3 kg after 30 weeks of treatment in patients with type 2 diabetes. The adverse effects are transient nausea and vomiting. The long-acting glucagon-like peptide-1 receptor agonists liraglutide and exenatide long-acting release reduce haemoglobin A1c by about 1.0-2.0% and have fewer gastrointestinal side-effects. The orally available dipeptidyl peptidase-4 inhibitors, that is sitagliptin and vildagliptin reduce haemoglobin A1c by 0.5-1.0%, are weight neutral and without gastrointestinal side-effects.SummaryThe benefits and position of the glucagon-like peptide-1 analogues and the dipeptidyl peptidase-4 inhibitors in the diabetes treatment algorithm will be clarified when we have long-term trials with hard cardiovascular endpoints and data illustrating the effects on the progression of type 2 diabetes.

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