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Published byMarley Kingham Modified over 10 years ago
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GLP -1 (gut hormone) + GIP = incretin effect =Augmentation of insulin after oral glucose Type 2 diabetics little incretin effect Reduced GLP-1 secretion GIP lost insulinotropic property GLP-1 broken down by DPP-4 Only for type 2 diabetes
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Inhibits incretin breakdown Indirectly increase own insulin secretion Moderate HBA1c reduction (~1%) Which one to choose?
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Start – 2 nd line: Metformin or Sulphonylurea + HBA1c ≥ 6.5% + not suitable for other one – 3 rd line: Metformin + Sulphonylurea + HBA1c ≥ 7.5% – Thiazolidinedione is an alternative in 2 nd line case but not 3rd Continue – HBA1c reduces by ≥ 0.5% in 6 months
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DPP-4 Inhibitor if: Weight gain would cause significant problem Thiazolidinedione contraindicated eg heart failure Previous intolerance or poor response to Thiazolidinedione
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GLP -1 (gut hormone) + GIP = incretin effect =Augmentation of insulin after oral glucose Type 2 diabetics little incretin effect Reduced GLP-1 secretion GIP lost insulinotropic property GLP-1 broken down by DPP-4 Only for type 2 diabetes
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Effects: Stimulates post-prandial insulin secretion Slows gastric emptying Reduces appetite Administered: Subcutaneous injection Twice daily
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Less hypos compared to insulin BIG benefit of weight loss Only licensed to lower blood sugars, not as weight loss agent Nausea and vomiting £830 per person per year
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Start: BMI ≥ 35 (+ probs assoc. with high wt) BMI < 35 + insulin unacceptable or weight loss beneficial to co-morbidities Continue Metformin and Sulphonylurea Combination with insulin Continue: HbA1c reduction ≥ 1.0% AND Initial body weight reduction ≥ 3%
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Metformin still first line DPP-4 Inhibitors alternative where Thiazolidinediones were previously only other oral option Exenatide - good for weight loss but ?help in sugar control Further new drugs on their way
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