Incretin -Based Therapy

Incretin -Based Therapy

Farzad Hadaegh MD

Associate Professor of 

Endocrinology

• A 58 year old woman with type 2 diabetes of 7y duration and no history of macrovascular disease. She is obese (BMI= 36 kg/m2), but says she eats a healthy diet and describes this. Her BP is 134/78 mm Hg, and she has microalbuminuria, but normal renal function and a lipid profile within target levels ranges.
• Simvastatin 40 mg daily and Enalapril 20mg daily. Glycated haemoglobin (HbA^1c) is 8.3% despite treatment with metformin 2000 mg/D and gliclazide 160 mg twice a day. How would you best manage her hyperglycaemia?

THE INCRETIN EFFECT AND GLUCAGON-LIKE PEPTIDE 1 THERAPY

GLP-1 a 30-amino-acid polypeptide derived from proglucagon gene

Rapidly secreted into bloodstream from enteroendocrine L-cells in distal small intestine & colon in response to food ingestion.

Within the L-cells of the small intestine, proglucagon peptide is processed by prohormone convertase  to

GLP-1

GLP-2 (a key regulator of small intestinal growth)

glicentin