title: [The incretin effect and type 2 diabetes].
abstract: In the gastrointestinal tract we produce hormones, called incretins, in response to food ingestion with a direct effect on pancreatic β and α cell improving the insulin and glucagon response to glucose. The effect consisting in a greater secretion of insulin with a glucose stimulus from the gut or IV injection is called "the incretin effect." The main incretins are: glucagon like peptide-1 (GLP1) and glucose-dependent insulinotropic peptide (GIP). The action of both incretins is very short due to a rapid inhibition in the circulation by an enzyme dipeptylpeptidase IV (DPP4). In type 2 diabetics, the incretin effect is altered and can be improved by elaboration of a GLP1 resistant to the action of DPP4 (GLP1 analogs) or by direct inhibition of DPP4 producing better effect of native GLP1 and GIP. We have exenatide a derivative from exendin 4, and liraglutide very similar to the native human GLP1. Three inhibitors of DPP4: sitagliptin, and vildagliptin and saxagliptin produce a prolonged inhibition of DPP4 and as a consequence increased effect of native incretins with better control of fasting and postprandial glucose and improve on A1c with a very few hypoglycemic events.
authors.affiliation: Clínica Cuauhtémoc y Famosa, Hospital Universitario "Dr. José E. González," Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
authors.forename: Cristina
authors.initials: C
authors.lastname: Quintanilla-García
authors.forename: Sergio
authors.initials: S
authors.lastname: Zúñiga-Guajardo
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000209:etiology*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use; D052216:Glucagon-Like Peptide 1 / Q000031:analogs & derivatives; D006801:Humans; D054795:Incretins / Q000502:physiology*; D050417:Insulin-Secreting Cells / Q000502:physiology
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D054795:Incretins; D052216:Glucagon-Like Peptide 1