Optimizing outcomes with incretin-based therapies: practical information for nurse practitioners to share with patients.
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.
Fleury-Milfort
Evelyne
E
Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. fleurymi@usc.edu
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*
D054873:Dipeptidyl-Peptidase IV Inhibitors; D000067757:Glucagon-Like Peptide-1 Receptor; D054795:Incretins; D018027:Receptors, Glucagon; D052216:Glucagon-Like Peptide 1