Comparison of efficacy between incretin-based therapies for type 2 diabetes mellitus

Abstract

Type 2 diabetes mellitus is widely prevalent and is often coexistent with obesity. Many of the available treatment options have side effects such as weight gain which often affect patient's willingness to continue the treatment. Effective weight loss, lack of significant hypoglycaemia, and favourable cardiometabolic profile make Incretin based therapies an attractive treatment option for type 2 diabetes. Incretin based therapies are available as either incretin mimetics (also called GLP-1 agonists) or incretin enhancers (DPP-4 inhibitors). Although agents in both these classes of incretin based therapy are effective through a common GLP-1 pathway, there are many differences amongst them including the route of administration, frequency of administration, effects on body weight, extent of glycaemic improvement. There are several trials evaluating these individual incretin based agents either as monotherapy or in combination with other anti-diabetic agents, however very few have looked into direct comparison amongst the agents in these two classes. This review is aimed to look at important mechanistic differences between incretin mimetics and enhancers through direct comparison trials and impact of these differences on biochemical, metabolic and patient satisfaction parameters.

Efficacy and safety of once daily liraglutide versus twice daily exenatide in type 2 diabetic patients in Qatar: an observational study

“…In line with the beneficial effects of exenatide and liraglutide in weight reduction approved in previous trials, the current study showed that patients’ weights were significantly reduced at 26 and 52 weeks in both groups compared to their baseline weight, except for the liraglutide group at 26 weeks. However, there were no treatment differences between the two groups at both timepoints similar to the LEAD‐6 study ( P = 0.2235) …”

“…GLP‐1 agonists lower HbA1C by approximately 1–2% . It also appears to offer advantages over other drugs by either keeping weight stable or even reducing weight while achieving good glycaemic control . GLP‐1 receptor agonists influence weight reduction mainly through a centrally mediated mechanism that regulates the appetite, satiety and food intake .…”

The Difficulty of Diabetic Therapy: An Observational Retrospective Study from Actual Clinical Practice

“…The probability of hypoglycemia with insulin and SD all together was two-fold higher than the risk for patients treated with DPP-4i and GLP-1 RA. Thus, both DPP-4i and GLP-1 RA provide a better glycemic control than therapy with insulin/SD [23]. Between treatment with DPP-4i and GLP-1 RA the lower risk of hypoglycemia was for patients with the first type of therapy.…”

Clinical use of dipeptidyl peptidase-4 and sodium-glucose cotransporter 2 inhibitors in combination therapy for type 2 diabetes mellitus

“…DPP-4 inhibitors selectively inhibit the DPP-4 enzyme and thereby slow the degradation of GLP-1 and GIP and increase their concentrations in circulation [8,14]. In a glucose-dependent manner, DPP-4 inhibitors improve b-cell sensitivity to glucose, increase insulin secretion, and decrease glucagon secretion [15].…”