title: Physiological aspects of the combination of insulin and GLP-1 in the regulation of blood glucose control.
abstract: Combining insulin with glucagon-like peptide-1 (GLP-1) receptor agonists or dipeptidyl peptidase-4 (DPP-4) inhibitors as glucose-lowering therapy for type 2 diabetes is a promising strategy that has gained considerable interest over the past few years. One advantage of this combination is the complementary mechanistic actions of insulin and GLP-1. Insulin increases glucose utilization and retards hepatic glucose production through direct actions in muscle, adipose tissue and the liver. On the other hand, GLP-1 stimulates insulin secretion, inhibits glucagon secretion and retards gastric emptying. Combining these effects results in powerful reductions in both fasting and postprandial glucose through diminished glucose entry into the bloodstream after food consumption, reduced hepatic production of glucose and increased glucose utilization. In addition, GLP-1 receptor agonists induce satiety, leading to decreases in food intakes and body weight, thereby preventing the weight gain often seen with insulin therapy. Clinical trials have verified that these physiological effects as a result of combining insulin with GLP-1 receptor agonists or DPP-4 inhibitors can indeed result in improved glycaemia, with limited risks of hypoglycaemia and weight gain.
authors.affiliation: Department of Clinical Sciences Lund, Lund University, B11 BMC, 221 84 Lund, Sweden. Electronic address: Bo.Ahren@med.lu.se.
authors.forename: B
authors.initials: B
authors.lastname: Ahrén
mesh_terms: D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005215:Fasting / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000008:administration & dosage* / Q000494:pharmacology; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000494:pharmacology; D054795:Incretins / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage* / Q000494:pharmacology
chemical_list: D001786:Blood Glucose; D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D054795:Incretins; D007328:Insulin; D052216:Glucagon-Like Peptide 1
keywords: Blood glucose control; Glucagon-like peptide-1; Incretin; Insulin