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Johns Hopkins Health Alert

How GLP-1 Drugs Work to Control Type 2 Diabetes

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Oral medication such as metformin (Glucophage) is generally considered the first line of treatment for someone with type 2 diabetes. When oral medication is not enough to control blood glucose levels, your doctor may prescribe an injected medication other than insulin. Known as incretin mimetics, drugs in this new class of type 2 diabetes medications mimic the action of glucagon-like peptide-1 (GLP-1), a hormone that triggers insulin production after a meal.

Exenatide (Byetta) was the first GLP-1 to hit the market; liraglutide (Victoza) was approved by the FDA in 2010. Byetta and Victoza act only when blood glucose levels are high, so they should not cause hypoglycemia (low blood sugar). As blood glucose decreases, these medications stop stimulating insulin release.

In a pharmaceutical company-sponsored study that compared Byetta and Victoza, participants on Victoza fared better all around. Victoza helped 54 percent of them lower their A1c to under 7 percent, while only 43 percent of those on Byetta lowered their A1c that much. Subjects on Victoza also lost a little more weight (7 pounds versus 6 pounds) and experienced half as many episodes of too-low blood glucose as those on Byetta.

GLP-1 drugs are not recommended for people with type 1 diabetes, severe kidney disease or severe gastrointestinal disease. Nausea is the most common side effect, though the comparison study found that it diminished more quickly in people taking Victoza (after six weeks versus 22 weeks in those on Byetta). Vomiting and diarrhea may also occur.

Because Byetta slows the absorption of oral drugs, you may need to take certain medications at least one hour before an injection of Byetta. There is some concern that Victoza may increase the risk of pancreatitis and thyroid cancer. Because these are new drugs, the long-term effects are still unknown. 

Posted in Diabetes on August 4, 2011

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Health Alerts registered users may post comments and share experiences here at their own discretion. We regret that questions on individual health concerns to the Johns Hopkins editors cannot be answered in this space.

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What's wrong with our current health care system? The first sentence of the story says it all: "Oral medication such as metformin (Glucophage) is generally considered the first line of treatment for someone with type 2 diabetes".

Health care reform must include the recognition and subsequent implementation of diet and exercise as the first line of treatment for the vast majority of type II diabetes cases, with medication (of any type) reserved for treatment of truly refractory cases.

Posted by: catdoc54 | August 7, 2011 4:48 PM

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