title: Optimizing outcomes with incretin-based therapies: practical information for nurse practitioners to share with patients.
abstract: OBJECTIVE
  To introduce the role of incretin therapies and suggest strategies for nurse practitioners to implement them in practice.
  
  
  METHODS
  PubMed, Medline, summary of product characteristics/package inserts.
  
  
  CONCLUSIONS
  Incretin-based therapies offer a new alternative to currently available agents. They provide adequate levels of glycemic control and are associated with low incidence of hypoglycemia and weight gain. Dipeptidyl peptidase-4 inhibitors, for example sitagliptin, have a modest effect on A1c levels (-0.7%) as monotherapy; however, they reduce A1c to a greater extent when combined with metformin ( approximately 2.0%). Typical starting dose of sitagliptin is 100 mg; dose adjustments are required in subjects with renal complications. Glucagon-like peptide-1 receptor agonists, exenatide and liraglutide, reduce A1c levels (often in excess of 1.5%) and body weight. Exenatide has a starting dose of 5 mug and is not recommended for patients with hepatic impairment or severe/end-stage renal disease. Liraglutide has been found to benefit from a stepwise dose escalation (i.e., 0.6 mg weekly increments) until a 1.8-mg dose is reached. Unlike exenatide, dose adjustments in patients with renal and hepatic complications are not required.
  
  
  CONCLUSIONS
  Incretin-based therapies may help to overcome some of the drawbacks of current therapies used to treat type 2 diabetes.
authors.affiliation: Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. fleurymi@usc.edu
authors.forename: Evelyne
authors.initials: E
authors.lastname: Fleury-Milfort
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use*; D052216:Glucagon-Like Peptide 1 / Q000627:therapeutic use*; D000067757:Glucagon-Like Peptide-1 Receptor; D054795:Incretins / Q000627:therapeutic use*; D009722:Nurse Practitioners; D024802:Nurse's Role; D010353:Patient Education as Topic; D018027:Receptors, Glucagon / Q000627:therapeutic use*
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D000067757:Glucagon-Like Peptide-1 Receptor; D054795:Incretins; D018027:Receptors, Glucagon; D052216:Glucagon-Like Peptide 1